co^ffl'lc\fN"cflf^Kf'. 


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RK57  W25  1899      A compendotdental 


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Dental 


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WARREISr 


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No.  15.     HALL.     GENERAL   PATHOLOGY    AND    MORBID  ANATOMY.    91 

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FRONTISPIECE.-A   STUDY. 

From    a    photograph    of    an    excellent    specimen, 
presented   to  the  author   by    Dr.  Amos    H.    Sibley. 


?QUIZ    COMPENDS?    No.  13. 


COMPEND 


OF 


DENTAL  PATHOLOGY 


AND 


DENTAL  MEDICINE, 


CONTAINING    THE    MOST    NOTEWORTHY    POINTS    UPON 

THE  SUBJECTS  OF  INTEREST  TO  THE  DENTAL 

STUDENT  AND  A  SECTION  ON 

EMERGENCIES. 


BY 

GEO.  W.  WARREN,   A.M.,  D.  D.S., 

CHIEF      OF      THE     CLINICAL     STAFF,     PENNSYLVANIA     COLLEGE     OF     DENTAL     SURGERY, 
PHILADELPHIA  ;    EDITOR   RICHARDSON'S    "  MECHANICAL    DENTISTRY,"  ETC. 


THIRD   EDITION.     ILLUSTRATED. 


PHILADELPHIA  : 

P.     BLAKISTON,  SON    &    CO., 

No.    IOI2  Walnut  Street. 
1899. 


Copyright,  1898,  by  P.  Blakiston,  Son  &  Co, 


PRESS  OF  WM.  F.  FELL  &  CO., 

1220-24  Sansom  Street, 
philadelphia. 


DEDICATED  TO 

PROFESSOR  C.  N.  PEIRCE,  D.  D.S., 

WHO,    AS    A   TEACHER    FOR    OVER     A     QUARTER     OF     A     CENTURY,    HAS     WITNESSED     MUCH 

AGITATION  AND  MANY  MODIFICATIONS  IN  PRACTICE,  RESULTING  IN  THE  PRESENT 

ADVANCED     POSITION      OF      DENTAL    THERAPEUTICS     AND     MATERIA 

MEDICA,  AND  WHOSE  WISDOM  HAS  BECOME  RIPENED  BY 

REFLECTION  AS  WELL  AS  BY  EXPERIENCE. 


NOTE. 


One  of  the  first,  and  sometimes  most  difficult,  lessons  the 
student  has  to  learn  is  how  to  study,  and  many  of  our  text- 
books are  so  voluminous  that  they  prove  a  source  of  embar- 
rassment to  one  just  beginning  his  professional  studies. 
Corapends  are  designed  to  facilitate  these  labors,  and  if 
properly  used  as  aids  to  more  elaborate  works,  they  have 
a  special  value. 

In  the  preparation  of  this  work  the  following  authorities 
have  been  freely  consulted  :  ''  The  American  System  of  Den- 
tistry," Litch ;  ''Principles  and  Practice  of  Dentistry," 
Harris;  "Dental  Medicine,"  Gorgas ;  "  Compend  of  Den- 
tistry," M.  Parreidt ;  "  Dental  Science,"  Ingersoll ;  "Chem- 
istry," Leffmann  ;  "Materia  Medica,"  Potter;  "Surgery," 
Gross;  "  Diseases  of  the  Jaw,"  Heath;  Dulles'  "What  to 
Do  First  "  ;  and  Butler's  "  Emergency  Notes."  I  am  also 
indebted  to  Professor  C.  N.  Peirce  for  many  valuable  sugges- 
tions. George  W.  Warren. 

March,  j8g8. 


VI 


CONTENTS. 


PAGE 

Anatomical  and  Physiological  Introduction, 9 

Development  of  the  Teeth, 9 

Structure  of  the  Teeth, 13 

Anatomy  of  the  Teeth, 17 

Decalcification  of  the  Temporary  Teeth,      23 

Dental  Pathology  and  Therapeutics, 27 

Inflammation, 27 

Diseases  of  the  Dental  Pulp  and  Membrane, 3^ 

Diseases  of  the  Hard  Dental  Structure, 41 

Injuries  and  Diseases  of  the  Maxillary  Bones,      46 

Defects  of  the  Palatine  Organs, 5^ 

Extraction  of  Teeth, 61 

Calcareous  Deposits, 63 

Dental  Medicine, 68 

Narcotics  and  Hypnotics, 68 

Analgesics  or  Anodynes, 7^ 

Anaesthetics, 74 

Stimulants, 89 

Tonics, 97 

Sedatives, m 

Antipyretics, I12 

Irritants, I '  3 

Astringents, • Il6 

Styptics  and  Haemostatics, 119 

Escharotics  or  Caustics,      120 

Antizymotics  (Antiseptics  and  Disinfectants),      124 

Cathartics, I37 

Emergencies, 141 

Weights  and  Measures, 167 

Index,     171 

vii 


ABBREVIATIONS. 


ABBREVIATION.  ,  LATIN.  ENGLISH, 

aa, Ana  (G.), Of  each. 

Ad  saturand. ,  .    ,    .  Ad  saturandum,     ,    .    .  Until  saturated. 

Ad  lib., Ad  libitum, At  pleasure, 

Aq. , Aqua, Water. 

Aq.    dest. , Aqua  destillata,      .    .    ,  Distilled  water. 

Comp. , Compositus, Compound. 

Ext., Extractum,      ....       An  extract, 

F.  or  Ft., Fiat  vel  fiant,      ....  Let  there  be  made. 

Garg. , Gargarysma, A  gargle. 

Gr., Granum,  vel  grana,    .    .  A  grain,  or  grains. 

Gtt., Gutta,  vel  guttee,    ...  A  drop,  or  drops. 

Infus., Infusuin, An  infusion, 

M., Misce, Mix, 

Mist., Mistura, A  mixture. 

O., Octarius, A  pint. 

Pil., Pilula,  vel  pilulse,     .    .  A  pill,  or  pills. 

Puiv,,       ,..,,.       Pulvis,  vel  pulveres,     .  A  powder,  or  powders. 

q.  s. , Quantum  sufficit,  ...  A  sufficient  quantity. 

R  ., Recipe,       Take. 

S., Signa, Write  directions, 

Spts., Spiritus, Spirits. 

ss., Semis, The  half. 

Syr., Syrupus, Syrup. 

Tinct., Tinctura, A  tincture. 

lb, Libra, A  pound. 

^  , Uncia, An  ounce. 

^  , Drachma,       A  drachm. 

^  , Scrupulus,      A  scruple. 

f  ^  , Fluid  uncia, A  fluid  ounce. 

f^, Fluid  drachma,      ,    .    .  A  fluid  drachm, 

TTf\^, ,  Minim,        A  drop, 

viii 


DENTAL    PATHOLOGY    AND 
DENTAL    MEDICINE. 


ANATOMICAL    AND    PHYSIOLOGICAL 
INTRODUCTION. 


DEVELOPMENT  OF  THE  TEETH. 
Follicular  Development  of  the  Deciduous  Teeth. 

The  Enamel  Organ. — During  the  seventh  week  of  foetal 
life  there  appears  on  the  border  of  the  jaw  a  ridge  of  epithe- 
lium, known  as  the  dental  ridge  ;  from  this  the  epithelial  folli- 
cles are  deflected  inward,  and  later  on  form  what  is  known  as 
the  Enamel  Organ.  Each  follicle  represents  an  individual 
tooth.  The  cells  active  in  the  formation  of  the  enamel  are 
known  as  enamelblasts  or  amelloblasts. 

The  Dentine  Organ. — A  papilla  arises  in  the  dermal 
tissue,  at  a  point  immediately  in  contact  with  the  rounded 
portion  of  the  enamel  organ — that  is,  from  below  in  the  lower 
jaw,  and  from  above  in  the  upper  jaw.  Simultaneously,  the 
bottom  of  the  enamel  organ  is  rendered  concave,  in  corres- 
pondence to  the  form  and  size  of  the  dentine  papilla,  cover- 
ing it  like  an  inverted  cup  ;  this  dentine  bulb  begins  to  assume 
the  form  of  the  tooth  from  the  ninth  to  the  tenth  week.  (See 
Fig  I.) 

^  9 


lO 


DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 


By  the  end  of  the  twelfth  week  the  follicles  of  the 
first,  or  deciduous,  set  of  teeth  are  completed. 

When  the  follicle  is  completed,  it  is  developed  by 


$■ 


—       /y 


A 


\ 


'-.9 


Fig.  2. 
Figs,   i  and  2. — Three  Stages  in  Developing  Enamel  Organs, 

a.  Dental  ridge,  c.  Infant  layer  of  cells,  d.  Epithelial  cord.  e.  Stellate  reticu- 
lum, f.  Dentinal  papilla,  g.  Inner  tunic,  h.  Outer  tunic,  i.  Transverse 
section  of  vessel,    k.  Formino;  bone. 


DEVELOPMENT    OF    THE    TEETH. 


II 


vascular  tissue,  forming  the  dental  sac ;  this  is  about  the 
fourteenth  week.  During  this  process  of  dentification  there 
appears  in  the  jawbone  a  groove  within  which  the  dentinal 
follicles  rest. 

Follicular  Development  of  the  Permanent  Teeth. 

The  follicles  of  the  permanent  teeth  begin  to  develop 
about  the  seventeenth  week  of  embryo  life ;  of  these,  the  first 
to  become  completed  are  those  of  the  four  first  molars,    at 


Fig.  3. 

a.  Outer  layer  of  mucous  membrane,  b,  b.  Calcifying  bone.  c.  Epithelial  cord. 
d.  Dentinal  papilla.  <?.  Calcifying  enamel,  f.  Enamel  germ.  h.  Permanent 
tooth  germ. 


about  the  twentieth  iveek ;  these  are  followed  by  the  follicles  of 
the  teeth  anterior  to  them,  which  are  completed  before  birth. 

The  ten  anterior  teeth  originate  from  the  necks  of  the 
primitive  follicles,  while  the  bud  of  the  follicle  of  the  first  per- 
manent  molar  originates  from  the  epithelial  lamina,  as  do  the 
deciduous  teeth,  and  back  of  all  the  follicles  of  the  temporary 
set. 

The  follicle  of  the  second  permanent  molar  origi- 
nates from   the  neck  of  the    follicle    of  the  first  molar,  and 


12  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

begins    to    form  about    the   twelfth  week   after  birth.     This 
budding  process  is  illustrated  in  Fig.  3. 

The  follicle  of  the  third  permanent  molar  begins  to 
develop  about  the  tliird  year  after  birth,  budding  from  the 
neck  of  the  follicle  of  the  second  molar,  and  is  in  its  follicular 
evolution  about  three  years,  thus  loosening  its  connection  with 
the  epithelial  band  at  about  the  sixth  year.  It  is  then  from 
twelve  to  fifteen  years  coming  to  such  maturity  as  to  emerge 
from  the  gum. 

Calcification. 

The  calcification  of  the  enamel  (by  the  deposition  of 
lime  salts)  commences  at  the  surface  of  the  dentine  and  pro- 
ceeds outward,  each  enamel  rod  taking  the  form  of  the  cell, 
which  in  their  compactness  take  on  various  shapes,  usually, 
however,  hexagonal,  and  the  lime  salts  from  each  are  deposited 
in  immediate  contact  with  each  contiguous  cell.  When  it  is 
completed  the  enamel  organ  disappears  and  nourishment  to 
the  enamel  can  only  be  had  through  the  surface  lying  nearest 
to  the  dentine,  which  is  accomplished  through  osmotic  action. 

The  calcification  of  the  dentine  commences  on  the 
surface  next  to  the  enamel  organ,  and  progresses  from  without 
inward,  this  being  the  point  where  mineralization  begins  in 
the  tooth  structure.  The  working  cells  of  the  dentine,  the 
odontoblasts,  throw  out  processes  around  which  the  lime  salts 
are  deposited,  the  processes  lengthening  with  the  thickening 
of  the  cap  of  dentine  ;  thus  forming  the  tubular  structure  of 
dentine.  The  processes  occupying  the  tubules  of  the  dentine 
are  simply  protoplasmic  prolongations.  As  age  advances, 
both  the  tubuli  and  fibrilli  decrease  in  size,  and  in  old  age 
the  extremities  are  nearly  or  wholly  obliterated. 

The  Cementum. — The  cells  active  in  the  formation  of 
the  Cementum  are  termed  Cementoblasts.  This  structure  is 
formed  from  the  pericemental  membrane,  remaining  as  the 


STRUCTURE    OF    THE    TEETH.  1 3 

residue  of  the  dental  sac,  and  becomes  adherent  to  the 
previously  calcified  dentine. 

Calcification  commences  about  the  seventeenth  week 
of  foetal  life,  in  the  temporary  incisors,  and  in  the  remaining 
temporary  teeth  during  the  seventh  month  ;  in  the  first  per- 
manent molars  during  the  eighth  month  ;  during  the  first  year 
in  the  permanent  incisors  and  cuspids ;  the  third  year  in  the 
bicuspids,  the  fifth  year  in  the  second  molars,  and  during  the 
eighth  year  in  the  third  molars. 

It  requires  about  two  years  for  calcification  to  become  com- 
pleted in  a  deciduous  tooth,  and  about  ten  years  in  a  per- 
manent tooth.     (See  Fig.  4.) 


STRUCTURE  OF  THE  TEETH. 

Physiologically,  the  teeth  are  divided  into  the  enamel, 
dentine,  ceraentum,  pulp,  and  pericemental  membrane. 

The  enamel  covers  the  crown  portion  of  the  dentine.  It 
is  the  hardest  and  most  dense  of  all  organic  substances,  hence 
it  serves  as  a  protection  to  the  dentine  from  abrasion,  and 
forms  a  greater  resistance  to  mechanical  force  and  the  action 
of  acids  as  well  as  to  beautify  the  teeth. 

The  dentine  gives  the  typical  form  of  the  teeth.  The 
chief  characteristics  which  adapt  it  to  constitute  the  main 
body  of  the  tooth  structure  are  its  density  and  vitality.  While 
it  encloses  within  it  the  pulp,  it  is  itself  enclosed  on  the  crown 
by  the  enamel  and  on  the  root  by  the  cementum.  The  im- 
perfect dentine  formations  which  sometimes  occur,  known  as 
interglobular  spaces,  found  near  the  surface  of  the  enamel, 
are  due  to  malnutrition  during  the  period  of  calcification. 
Pits  in  the  enamel  will  very  often  be  found  accompanying 
these  interglobular  spaces,  and  are  due'to  the  same  causes. 

The  cementum,  a  somewhat  dense  substance,  covers  the 


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STRUCTURE    OF    THE    TEETH. 


15 


root  portion  of  the  dentine.  Its  special  use  is,  by  being  inter- 
mediate in  the  density  of  its  structure,  to  form  a  union  of  the 
soft  tissue  of  the  root  membrane  with  the  dentine,  thus  aiding 
the  pulp  in  nourishing  the  tooth,  and  preserving,  in  a  measure, 
the  vitality  of  the  tooth  after  the  pulp  may  have  been  de- 
vitalized. 


Fig.  5. — Represents  Vertical  Sections  of  the  Upper  Cuspid  and 
Molar  Teeth,  showing  the  Relation  and  Relative  Thick- 
ness OF  THE  Hard  Dental  Tissues;  also  Size,  Shape,  and 
Location  of  the  Pulp  Chamber. 

E.  Enamel.     C.  Cement.     D.  Dentine.     P.  Pulp  cavity. 


The  pulp  is  enclosed  by  the  dentine,  and  represents  the 
shape  of  the  tooth  in  a  diminished  size.  It  is  composed  of 
nerve,  vein,  artery,  and  formative  tissue.  This  body  is  the 
mere  shrunken  condition  to  which  the  tooth  germ,  or  dental 
papilla,  is  reduced,  after  it  has  normally  accomplished  the 
work  of  dentification. 


1 6      DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

The  pulp  is  exquisitely  sensitive  and  highly  vascular;  it 
is  of  a  reddish-gray  color  and  is  enveloped  in  an  exceedingly 
delicate  membrane,  which  is  continuous  with  the  peridental 
membrane  and  is  adherent  to  the  wall  of  the  pulp  cavity. 

The  pulp  is  divided  into  two  portions — the  crown  or  body, 
which  occupies  the  crown  cavity,  and  the  extremities,  which 
occupy  the  root  canal. 

In  advanced  age  this  body  often  undergoes  considerable 
change;  the  size  is  sometimes  much  diminished,  while  again 
it  is  found  as  a  shriveled  and  nearly  insensitive  mass. 

This  degeneration  is  due  to  the  irritation  and  shock  to  which 
the  teeth  are  liable  at  this  time  of  life,  owing  to  their  worn 
and  abraded  condition.  If  the  irritation  is  mild  and  constant, 
and  the  patient  of  a  calcic  diathesis,  a  further  deposit  of  lime 
salts  is  made,  and  the  pulp  diminished  in  size  in  consequence. 
But  where  the  irritation  is  more  severe  it  is  apt  to  cause  con- 
gestion and  death  of  the  pulp.     • 

The  pericemental  membrane  is,  as  the  name  implies, 
the  membrane  which  surrounds  or  invests  the  roots  of  the  teeth. 
It  is  a  richly  vascular,  fibrous  structure,  and  is  the  nutrient 
organ  of  the  cemenlum.  It  is  also  the  organ  of  touch  in  the 
tooth,  as  through  the  nerves  of  this  membrane  every  impres- 
sion upon  the  tooth  is  reported  to  the  brain.  It  serves,  too, 
to  unite  the  tooth  to  the  alveolus  by  its  continuation  through- 
out the  alveolar  cavities  or  sockets,  and  is  connected  at  the 
dental  foramen  with  the  pulp,  as  previously  indicated. 

The  peridental  membrane  also  serves  as  a  cushion,  per- 
mitting a  certain  passive  motion  by  which  the  teeth  are  pro- 
tected from  injury  by  blows  and  concussions  which  they  are 
apt  to  receive  during  the  performance  of  their  peculiar  function 
of  tearing  and  grinding  during  the  process  of  mastication. 


ANATOMY    OF    THE    TEETH.  1 7 

ANATOMY  OF  THE  TEETH. 

Anatomically,  the  teeth  are  divided  into  three  parts,  the 
crown,  neck,  and  root,  the  crown  being  that  portion  which 
projects  freely  into  the  mouth  ;  the  neck  is  surrounded  by  the 
gums,  and  the  root  is  that  portion  covered  by  the  alveolar 
process  of  the  jaw  and  by  which  the  whole  tooth  is  held 
securely  m  position.  In  old  age  the  gums  recede,  exposing 
the  neck,  and  a  part  of  the  root  is  sometimes  exposed  in  con- 
sequence of  atrophy  of  the  alveolar  process. 

The  temporary  denture  consists  of  twenty  teeth, 
divided  into  three  groups — the  incisors,  cuspids,  and  molars. 
The  relative  position  and  number  these  groups  bear  to  one 
another  is  expressed  in  the  following  formula:  — 

M2  Ml  C  I2  Ii    I    Ij  I2  C  Ml  M2. 
M2  Ml  C  I2  Ii    I    Ii  lo  C  Ml  M^. 

In  the  temporary  teeth  the  proportion  of  the  length  to  the 
width  is  marked,  they  being  somewhat  shorter  than  their  suc- 
cessors, the  permanent  teeth.  The  color  of  the  temporary 
teeth  is  of  a  milky  or  bluish  white,  while  that  of  the  per- 
manent presents  a  yellowish  appearance.  In  determining 
between  the  temporary  and  permanent  teeth  the  observer  will 
be  aided  by  the  relative  size  and  color,  and  by  remembering 
that  the  former  are  somewhat  loose,  and  have  a  marked 
depression  at  the  neck,  just  at  the  union  of  the  enamel  and 
cementum. 

The  permanent  denture  consists  of  thirty-two  teeth, 
which  are  divided  into  four  groups,  namely :  incisors  (cut- 
ting), cuspids  (tearing),  bicuspids  (crushing),  and  molars 
(grinding),  according  to  the  following  formula  :  — 

M3  M2  Ml  BC2  BCi  C  I2  Ii    I    Ii  I2  C  BCi  BC2  Ml  M,  M3. 
M3  M2  Ml  BC2  BCi  C  I2  Ii    i    Ii  I2  C  BCi  BC2  Ml  M2'  Mg. 


i8 


DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 


The  relation  between  the  permanent  and  temporary  teeth 
is  shown  in  the  accompanying  diagram,  Fig.  6. 

The  anterior  twenty  teeth,  namely,  the  incisors,  cus- 
pids, and  bicuspids,  each  have  one  root,  except  the  first  upper 
bicuspid,  which  in  about  eighty  per  cent,  has  two  roots,  one 
labial  and  one  palatine.  The  roots  of  the  upper  incisors  are 
rounded  ;  those  of  the  bicuspids  are  flattened  laterally.     The 


3  3 


CpQsQoQ^^ 


Fig.  6.* — The  Figures  i,  2,  3,  etc.,  Indicate  the  Groups  of  Teeth 
AND  THE  Order  of  their  Appearance. 


roots  of  the  lower  incisors  are  the  most  flattened,  while  the 
root  of  the  cuspid  combines  partially  the  roundness  of  the 
incisor  and  the  flatness  of  the  bicuspid.  The  upper  molars 
have  three  roots  each,  two  buccal  and  one  palatine,  which  are 
usually  of  a  round  shape.  While  the  lower  molars  have  but 
two  roots,  one  anterior  and  one  posterior,  these  are  laterally 


*"  Disease  of  the  Digestive  Organs  in  Infancy  and  Childhood,"  2d  ed. 
By  Dr.  Louis  Starr. 


ANATOMY    OF    THE    TEETH. 


19 


flattened,  and  extend  from  the  buccal  to  the  lingual  surface  of 
the  tooth.  The  roots  of  the  third  molar  or  wisdom  tooth  are 
subject  to  the  same  rules  as  those  of  other  molars,  but  they 
are  subject  to  a  great  number  of  exceptions. 

The  crowns  of  the  teeth  present  several  surfaces  for 
examination,  which  are  named  according  to  their  position 
and  use.  Those  of  the  incisors  and  cuspids  presenting 
toward  the  lips  are  called  labial  surfaces ;  while  the  same 
outer  surfaces  of  the  bicuspids  and  molars  are  called  buccal, 


Fig.  7. — The  median  line  is  shown  at  M,  labial  surface  at  L,  cutting  edge 
at  C,  palatal  surface  at  P,  and  approximal  surfaces  at  A,  of  typical 
superior  central  incisors. 


being  next  to  the  cheeks,  and  the  opposite  or  inner  surfaces 
of  all  the  teeth,  that  portion  presenting  toward  the  tongue, 
are  called  the  lingual  surfaces.  Some,  however,  use  the  term 
*' palatine  surfaces  "  for  tliose  of  the  upper  jaw  and  "lingual" 
for  those  of  the  lower.  While  this  is  not  necessary,  it  seems 
perfectly  proper. 

Those  surfaces  of  the  teeth  that  lie  adjacent  or  next  to  the 
adjoining  teeth  are  called  proximate  or  proximal  ;  these  are 
more  closely  defined  or  divided  by  the  terms  mesial d.\^d.  distal. 
They  are  so  n„amed  by  their  relative  position  to  the  central  or 


20 


DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 


median  line  of  the  face.  Those  proximate  surfaces  which 
face  toward  the  median  line  are  called  mesial  surfaces  ;  and 
the  opposite,  or  those  most  distant  from  this  line,  are  called 
the  distal  suj-faces.  These  several  surfaces  are  clearly  shown 
in  Figs.  7,  8,  and  9. 

The  cutting  edges  of  the  anterior  teeth  and  the  grinding 


Fig.  8. — The  Several  Surfaces 
OF  A  Superior  Cuspid  Tooth. 

L  indicates  the  labial,  P,  the  palatal, 
and  A,  the  approximal  surfaces. 


Fig.  9. — TheThreeRoots,Neck, 
AND  Crown  of  a  Superior 
Molar  Tooth,  Presenting 
Both  the  Buccal  and  Ap- 
proximal Aspect. 

The  masticating  surface  is  indicated 
at  M. 


surfaces  of  the  bicuspids  and  molars  are  called  the  occluding 
surfaces. 

The  Normal  Articulation. 
In  the  upper  jaw  the  arch  is  larger  than  in  the  lower, 
especially  in  the  anterior  portion  of  it.  The  upper  and  lower 
teeth,  therefore,  do  not  meet  perpendicularly  in  articulating; 
the  lower  incisors  and  cuspids  articulate  on  the  palatine  sur- 
faces of  the  corresponding  teeth  in  the  upper  jaw.  The  cusps 
of  the  lower  bicuspids  and  molars  articulate  in  the  grooves 
and  furrows  of  the  upper,  and  the  teeth  are  so  arranged  in 
size  and    position   that  each  tooth    in   the  upper  jaw  when 


ANATOMY    OF    THE    TEETH. 


21 


articulating  occludes  with  two  of  the  lower  teeth.     This  is 
illustrated  in  Fig.  lo. 


Fig.   io. 


Primary  Dentition. 

First  dentition  takes  place,  normally,  in  the  order  given 
in  the  following  formula  :  — 

Central  incisors, 5th  to  7th    month. 

Lateral        "  9th  to  nth     " 

First  molars, 12th  to  14th     " 

Cuspids, 14th  to  i8th     " 

Second  molars, i8th  to  25th     " 

Marked  Exceptions. — Some  children  are  born  with  a 
few  teeth  erupted,  and  there  are  cases  reported  where  the 
entire  temporary  set  have  been  erupted  at  birth  ;  there  are  also 
cases  on  record  of  adults  vv^ho  have  been  edentulous  from  birth. 
But,  as  indicated,  these  are  rare  exceptions.  The  force 
which  causes  the  teeth  to  emerge  is  called  vital  force,  and 


2  2  DENTAL    PATHOLOCxY    AND    DENTAL    MEDICINE. 

operates  by  growth,  developing  first  the  neck,  then  proceed- 
ing gradually  to  the  apical  end  of  the  root. 

Lesions  Incident  to  First  Dentition. 

Though  the  eruptive  process  of  dentition  is  a  physiological 
action,  it  is  very  often  attended  by  serious  irritation.  During 
early  childhood  the  tissues  are  all  softer,  more  vascular  and 
sensitive,  the  nervous  system  predominating.  Hence  it  is 
that  the  system  at  the  period  of  first  dentition  is  so  susceptible 
to  nervous  impressions.  In  infancy,  too,  the  system  is  less 
capable  of  combating  diseases,  and  a  large  portion  of  the 
alarmingly  great  mortality  of  this  period  is  traceable  to  the 
irritation  caused  by  dental  evolution. 

The  indications  of  the  eruption  of  the  teeth  are,  first,  an 
increased  flow  of  saliva — a  healthy  manifestation,  as  it  tends 
to  keep  the  mouth  moist  and  cool.  This  "  drooling  "  is  due 
to  the  irritation  of  the  trifacial  or  fifth  pair  of  nerves,  which 
is  sensory  to  the  teeth  and  nutrient  to  the  salivary  glands. 
When  the  irritation  becomes  more  pronounced,  the  secretions 
are  somewhat  checked  and  the  mouth  becomes  hot  and  dry, 
the  cheeks  unusually  red,  eruptions  appear  upon  the  face, 
and,  indeed,  sometimes  over"  the  whole  body;  with  ulcera- 
tions upon  the  tongue  and  mucous  membrane  of  the  mouth 
and  inflammation  of  the  gum  over  the  advancing  tooth  or 
teeth.  A  condition  quite  opposite  to  the  above  in  appearance 
is  a  w/ii/e  and  hardened  gum  overlying  the  advancing  tooth 
or  teeth.  This  offers  a  greater  resistance  than  the  inflamed 
condition  and  is  often  neglected,  especially  by  physicians, 
owing  to  the  absence  of  any  appearance  of  congestion. 

The  child  becomes  wakeful,  peevish,  and  cross,  loses  his 
appetite,  and  if  relief  is  not  then  given  this  may  be  followed 
by  persistent  nausea,  diarrhoea,  and  spasms  or  convulsions. 

Treatment. — The  first  thing  is  to  remove  the  irritation 


ANATOMY    OF    THE    TEETH.  23 

by  freely  lancing  the  gums  over  the  advancing  teeth.  The 
manner  of  doing  this  is  admirably  and  fully  shown  in  the  ac- 
companying illustration  (Fig.  ii),  which  is  taken  from  a  paper 
by  the  late  Dr.  James  W.  White,  in  the  ''American  System 
of  Dentistry."  If  the  convulsive  stage  is  reached,  the  patient's 
feet  should  be  placed  in  hot  mustard  water,  and  cold  cloths 
applied  to  the  head,  or  the  entire  body  put  in  a  warm  bath ; 


Fig.  II. 

such  measures  cause  muscular  relaxation  and  have  a  soothing 
effect  upon  the  nervous  system. 

Decalcification  of  the  Temporary  Teeth. 

The  temporary  teeth  must  be  removed  before  the 
permanent  can  erupt  in  their  normal  position;  this  takes 
place  normally,  by  the  absorption  or  decalcification  of  the 
roots. 

This  process  usually  commences  at  the  apex  of  the  root,  on 
the  side  nearest  to  the  successional  tooth  ;  this,  however,  is 
not  invariably  the  case.  Absorption  may  coaimence  at 
several  and  distinct  points,  sometimes  on  the  labial  side — 
that  most  distant  from  the  succeeding  tooth. 


24      DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

The  cause  and  manner  in  which  the  roots  of  the  temporary 
teetli  are  absorbed  has  been  the  subject  of  much  and  careful 
study  by  such  advanced  investigators  in  the  domain  of  dental 
science  as  Tomes,  Peirce,  Bodeker,  Abbot,  and  others. 

It  was  thought  for  a  long  while  that  the  pressure  caused  by 
the  advance  of  the  permanent  teeth  was  the  sole  cause  for  the 
decalcification  of  the  primary  teeth  ;  but  it  is  now  generally 
conceded  that  //  is  simply  the  result  of  a  physiological  action 
and  not  a  mechanical  force.  The  fact  that  the  decalcification 
of  the  deciduous  teeth  is  sometimes  successfully  accomplished 
in  the  absence  of  the  corresponding  permanent  teeth  adds 
much  to  the  evidence  that  their  presence  and  pressure  is  not 
essential. 

Prof.  Peirce,  in  the  ''  Transactions  of  the  American  Dental 
Association,"  says  :  ''  The  several  conditions  which  are  always 
present  and  essential  are  readily  recognized,  but  the  part  each 
plays  is  not  easily  ascertained.  The  place  of  its  commence- 
ment, at  the  end  of  the  root,  the  retention  of  pulp  vitality, 
and  the  presence  of  a  vascular  papilla  in  close  proximity  to 
the  absorbing  surface,  with  the  fact  that  the  surface  of  this 
papilla  is  rich  in  giant-cells,  termed  '  osteoclasts,''  are  evidently 
essential  accompaniments,  and  the  absence  of  any  one  of 
them  would  certainly  militate  against  the  completion  of  the 
process." 

And  in  another  place  the  same  writer  says:  ''That  the 
organ  has  served  its  purpose,  and  that  the  nourishment  which 
had  previously  been  appropriated  by  it  is  diverted  or  relegated 
to  its  successors,  is  probably  the  most  plausible  explanation 
we  can  give  of  this  interesting  physiological  process." 

Decalcification  of  the  deciduous  teeth  commences 
in  the  central  incisors  at  about  the  fourth  year;  in  the 
lateral  incisors  in  the  fifth  year ;  in  the  first  molars  the  seventh 
year,  the  second  molars  the  eighth  year,  and  the  cuspids  the 


ANATOMY    OF    THE    TEETH. 


25 


ninth  year.     After  decalcification  commences  in  a  tooth,  it 
.takes  about  three  years   for   it  to  accomplish  its  work.     (See 

Fig.  12.) 

Second  Dentition. 

In  a  harmonious  development  of  the  teeth  and  jaws,  the 
indications  of  the  time  approaching  for  the  development  of 
the  permanent  teeth  are  the  expanding  of  the  alveolar  ridge 
and  the  spreading  apart  of  the  deciduous  teeth. 


Fig.  12. — Decalcification  of  the  Deciduous  Teeth. 

(From  a  diagram  prepared  by  Prof.  C.  N.  Peirce,  1884.) 


The  emergence  of  the  permanent  teeth  takes  place, 
normally,  in  the  order  given  below : — 

First  molars, 6  to  7  years. 

Central  incisors, 7  to  9 

Lateral       "          8  to  10 

First  bicuspids, 10  to  ii 

Second     "            11  to  12 

Cuspids, 12  to  13 

Second  molars, 12  to  13 

Third     "              16  to  25 

Exceptions. — Deviations  from   the  order  of  appearance 
and  the  respective  ages  as  given  above  occur ;  it  is  usually  in 


26  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Strong  children    that  the    teeth  appear   at  a   later  period,  a 
scrofulous  diathesis  being  indicated   in  premature  dentition.. 

Third  Dentition. 

Cases  of  third  dentition  are  reported  by  a  number  of 
writers,  but  undoubtedly  the  majority  of  these  reports  refer 
to  teelh  that  in  reality  were  part  of  the  second  set,  which 
failed  to  emerge  at  the  normal  time,  and  had  only  appeared 
in  old  age  when  there  was  sufficient  room  for  them,  or  the 
jaws  had  atrophied. 

The  writer  has  extracted  two  well-developed  third  molar 
teeth  (which  had  never  emerged  from  the  gums)  for  a  patient 
sixty  years  of  age  ;  this  was  after  the  extraction  of  the  second 
molar  roots.  It  was  known  that  the  patient  had  never  had 
any  "wisdom  teeth." 

Anomalies  of  Number. — Supernumerary  teeth  are  espe- 
cially frequent  in  the  anterior  portion  of  the  superior  maxil- 
lary. When  sufficient  room  is  wanted  for  them,  they  may 
stand  within  or  without  the  arch.  Usually  the  shape  of  both 
the  crown  and  root  of  these  teeth  is  conical,  while  the  shape 
of  the  crown  of  those  found  in  the  posterior  part  of  the 
mouth  is  cuboidal — resembling  the  molars. 

Dentures  from  which  normal  teeth  are  missing 
are  more  frequent  than  those  containing  supernumerary  teeth. 
Occasionally  the  space  from  which  the  permanent  tooth  is 
missing  may  be  occupied  by  a  temporary  tooth.  Some- 
times temporary  teeth  may  be  seen  in  the  mouth  of  persons 
twenty-five  and  thirty  years  of  age  j  in  these  cases  the  per- 
manent ones  are  generally  retained  in  the  jaw,  and  may  erupt 
later. 


INFLAMMATION.  27 

DENTAL  PATHOLOGY  AND  THERAPEUTICS. 

Dental  pathology  treats  of  the  origin  and  progress  of 
the  various  diseases  to  which  the  teeth  and  the  surrounding 
oral  tissues  are  liable. 

Dental  therapeutics  considers  the  medicines  and  reme- 
dies used  in  the  treatment  of  such  diseases. 

Disease,  pathologically  considered,  is  any  abnormal  con- 
dition in  those  processes  which  constitute  perfect  health.  It 
is  but  the  normal  physiological  force  perverted^  tearing  down 
what  it  had  before  built  up.  This  cannot  always  be  recog- 
nized at  first,  as  it  may  be  confined  to  an  area  so  small  as  to 
involve  but  a  single  cell.  Its  chief  manifestations  are  ex- 
pressed by  the  word  inflammation. 

Inflammation. 

The  most  commonly  observed  features  of  inflammation  are 
heat,  redness,  swelling,  pain,  and  impaired  function,  modified 
only  by  peculiarities  of  the  structure  and  intensity  of  action. 
It  is  a  series  of  changing  conditions,  each  the  result  of  the 
preceding  one. 

The  first  cause  is  irritation ;  that  is,  the  slightest 
foreign  influence  disturbing  the  harmony  of  the  functions  of 
the  tissues.  It  is  most  readily  traced  in  the  vascular  system. 
In  this,  the  first  stage  of  inflammation,  the  capillary  vessels 
are  excited  into  active  contraction  and  relaxation,  quickening 
the  circulation  of  the  blood,  inducing  warmth,  and  causing 
some  discomfort. 

Acute  inflammation,  or  the  second  stage,  is  charac- 
terized by  warmth,  a  sense  of  fullness,  slight  swelling,  and 
increasing  pain  ;  the  abnormal  volume  of  blood  in  the  parts 
piesses  upon  the  nerve  filaments  supplying  the  inflamed  tissue, 
causing  pain  in  accordance  with  the  expansion  of  the  vessels. 


28  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Chronic  Inflammation. — In  prolonged  inflammation, 
the  functions  of  the  parts  become  somewliat  changed,  adapting 
themselves  to  the  surrounding  conditions  ;  thus,  the  tissues 
involved  become  less  susceptible  to  the  impression  of  an 
irritant,  and  comparatively  little  pain  follows,  this  being  one 
of  the  most  noticeable  characteristics  of  chronic  disease. 

Treatment. — In  treating  inflammation  eff'ort  is  made  to 
effect  resolution,  or  to  hasten  suppuration. 

Resolution  is  the  subsidence  of  inflammation  and  a 
return  of  the  tissues  to  normality. 

Suppuration,  or  pus  formation,  being  the  breaking  down 
of  the  parts,  the  debris  of  which,  with  white  blood  corpuscles, 
forms ///i-. 

The  remedies  used  are,  first,  to  remove  the  cause, — that 
is,  the  irritant, — to  administer  laxatives,  and  apply  sedatives 
and  stimulants. 

The  chronic  stage  of  the  inflammatory  process, 
if  not  checked,  may  result  in  hypertrophy,  induration,  tume- 
faction, or  congestion  of  the  tissues. 

Hypertrophy. 

Hypertrophy  is  an  excessive  growth  of  normal  tissue  by 
the  multiplication  of  cell  elements.  Of  the  oral  tissues,  the 
gum  and  mucous  membrane  are  the  most  liable  to  this  dis- 
ease. The  usual  form  recognized  is  in  a  growth  of  the  free 
border  of  the  gum,  lying  loosely  against  the  teeth,  in  some 
cases  extending  to  the  cutting  edges.  Another  form  consists 
in  the  thickening  of  the  entire  gums,  covering  the  teeth  to 
such  an  extent  that  only  the  masticating  surfaces  are  visible ; 
the  hypertrophied  portion  being  firm  and  dense,  protruding 
the  lip  to  such  an  extent  as  to  cause  deformity ;  this  latter 
form  of  hypertrophy  of  the  gum,  however,  is  rare. 

Treatment  consists  in  cutting  away  the  long  points  and 


TUMEFACTION.  29 

borders  of  the  gum  down  to  the  necks  of  the  teeth,  and  then 
reducing  the  inflammation  with  stimulants  and  astringents. 

Induration. 

Induration  is  a  circumscribed,  hardened  swelHng  ;  it  is  an 
enlargement  of  individual  cells,  and  not  a  multiplication  as  in 
hypertrophy.  In  this  stage  of  chronic  inflammation  the  func- 
tions of  the  tissue  involved  are  inactive,  the  circulation  being 
very  much  retarded.  It  may  manifest  itself  in  the  gum,  in 
the  muscles  of  mastication,  or  in  the  muscles  of  the  neck. 

Treatment. — In  induration  of  cheek  or  neck,  apply  hot 
cloths  and  an  active  stimulant^  such  as  capsicum.  When  the 
disease  is  in  the  gum,  apply  capsicum  plaster  and  lance  freely. 

TUMEFACl'ION. 

Tumefaction  is  a  condition  of  chronic  inflammation,  by 
which  is  produced  an  abnormal  amount  of  tissue,  of  a  different 
kind  from  the  surrounding  tissue,  exhibiting  a  difference  in 
color  and  texture.  Tumefaction  as  found  in  the  mouth  is 
divided  into  epulis,  cystic,  and  vasctilar  tiuno's. 

Epulis  tumors  originate  in  the  periosteum,  and  are  usu- 
ally found  in  the  interspaces  of  the  anterior  teeth.  They  are 
fibrous  in  structure,  and  usually  of  a  dark  red  color. 

Treatment  consistsof  excision,  care  being  taken  to  remove 
all  the  abnormal  tissue  ;  the  bistoury  should  be  passed  well 
around  and  under  the  tumor,  as  deep  as  the  periosteum ;  after 
removing  the  growth  as  entire  as  possible  with  the  knife,  car- 
bolic acid  should  be  applied,  to  destroy  the  vitality  of  any 
fibres  that  should  remain. 

Cystic  tumors  originate  in  the  mucous  membrane  ;  they 
are  membranes  in  structure,  of  a  lighter  color  than  the  normal 
mucous  membrane,  and  are  filled  with  a  viscid  fluid. 

Treatment  consists  in  lancing  at  the  lowest  points,  and 


3©  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

emptying  the  contents  by  pressure,  after  which  applications  of 
stimulants  and  astringents  should  be  made. 

Vascular  tumors  arise  from  some  blood-vessel  supplying 
the  oral  tissues.  They  are  usually  of  a  dark  red  color,  and 
highly  vascular;  they  have  a  smooth  and  shiny  surface,  and 
are  more  or  less  fibrous. 

Treatment  same  as  in  epulis  tumors. 

Congestion  is  also  often  the  result  of  inflammatory  pro- 
cesses. 

The  prominent  feature  of  congestion  is  blood  stasis, 
causing  severe  pain  with  each  pulsation  of  the  heart.  The 
capillary  vessels  in  the  inflamed  parts  being  engorged,  the 
blood  rebounds  at  each  pulsation  of  the  heart,  thus  causing 
the  throbbing  pain.  The  pain,  however,  is  sometimes  inter- 
mittent, by  the  capillaries  being  broken  through,  relieving 
the  pressure  temporarily. 

Treatment  is  to  apply  stimulants  and  sedatives. 

Alveolar  Abscess. 

An  abscess  is  a  circumscribed  cavity,  containing  pus — 
circumscribed  by  the  development  of  a  soft  membrane, 
forming  a  sac,  restraining  the  pus  from  passing  into  the  sur- 
rounding tissues,  causing  it  to  seek  the  surface  at  the  point 
of  the  least  resistance,  here  parting  the  tissues,  forming  an 
escape  called  2,  fistulous  opening. 

An  alveolar  abscess  is,  as  the  name  indicates,  an  abscess 
originating  within  the  alveolar  walls.  It  is  the  result  of  inflam- 
mation of  the  pericemental  membrane,  consequent,  usually, 
upon  the  death  and  septic  decomposition  of  the  tooth  pulp. 

Symptoms  of  alveolar  abscess  are  congestion  and  inflam- 
mation of  the  gunis  about  the  aff"ected  tooth ;  severe  pain 
which  is  often  accompanied  by  considerable  fever.  There  is 
also  apparent  elongation  of  the  tooth,  caused  by  inflammation 


ALVEOLAR    ABSCESS.  3 1 

of  the  pericemental  membrane  and  accumulation  of  pus  in 
its  socket ;  the  pus  formed,  being  confined  in  the  apical  space 
between  bony  walls,  causes  considerable  pressure  as  it  accumu- 
lates. The  bone  in  this  neighborhood  is  not  of  a  very  hard 
nature,  and  in  consequence  is  readily  destroyed  by  the  pus 
in  its  efforts  to  seek  the  surface.  During  the  time  the 
pus  is  penetrating  the  bone  the  patient  suffers  most  ;  the 
pain  at  this  stage  being  very  severe  and  of  a  throbbing 
character. 

The  features  become  swollen  and  disfigured  on  the  affected 
side;  the  eye  is  sometimes  entirely  closed,  and  the  jaws  so 
stiff  that  the  mouth  can  not  be  opened  to  any  considerable 
distance. 

Other  causes  than  that  of  the  death  and  decomposition  of 
the  pulp  may  give  rise  to  alveolar  abscess  ;  any  foreign  matter, 
such  as  filling  material,  being  forced  through  the  apex  of  the 
root,  calcic  deposits  within  the  walls  of  the  alveolus,  fiecrosed 
root  or  bone,  impacted  teeth,  etc.,  may  cause  sufficient  inflam- 
mation of  the  periosteum  to  produce  an  abscess,  all  the  suc- 
cessive stages  of  inflammation  being  involved  in  the  formation 
of  an  abscess,  from  irritation  to  suppuration. 

Treatment. — The  surgical  and  local  treatment  consists 
in  gaining  free  access  to  the  diseased  parts,  and  removing  the 
cause,  and  breaking  up  the  sac  of  the  abscess.  In  securing 
ready  access  to  the  point  of  accumulation  it  is  best  to  first 
open  up  the  canals  of  the  affected  tooth.  In  doing  this  it  is 
better  to  sacrifice  good  tooth  structure  than  to  attempt  to  work 
around  corners  and  through  too  small  a  canal,  being  careful  to 
follow  the  line  of  the  canal,  and  not  perforate  the  side  of 
the  root;  after  which  the  canal  should  be  thoroughly  irrigated 
with  peroxide  of  hydrogen  followed  by  a  dressing  of  an 
eff"ective  antiseptic  and  germicide  before  filling. 

Where  the  abscess  has  advanced  to  any  considerable  extent. 


32  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

it  will  sometimes  be  found  necessary  to  more  freely  open  or 
enlarge  the  fistulous  canal  by  drilling  in  through  the  gum  and 
alveolar  process  over  the  affected  tooth  with  a  medium-sized 
rose-head  burr  revolved  by  the  dental  engine.  In  so  doing 
the  parts  may  be  more  thoroughly  drained  and  treated,  and 
the  sac,  when  attached  to  the  end  of  the  root,  can  be  more 
readily  reached  and  broken  up.  If  the  patient  is  in  an  other- 
wise healthy  condition,  nature  will  finish  the  work  by  throwing 
off  the  broken-down  tissue  and  developing  new  granulations, 
without  further  treatment.  It  would  be  advisable,  however, 
to  assist  in  throwing  off  the  foreign  matter  by  injecting 
peroxide  of  hydrogen  and  warm  water  freely  into  the  enlarged 
fistulous  opening  and  socket. 

Where  the  patient  is  of  low  vitality,  or  the  abscess  of  long 
standing,  other  therapeutic  treatment  must  follow  the  surgical 
before  a  cure  can  be  accomplished.  After  cleansing  the 
canals  thoroughly  with  peroxide  of  hydrogen,  as  before 
stated,  some  one  of  the  more  efficient  antiseptic  and  disin- 
fectant remedies,  such  as  carbolic  acid  and  iodine,  or  oil  of 
cinnamon,  should  be  applied  on  a  strand  of  floss  silk,  or  a  few 
fibers  of  cotton,  or  asbestos,  which  should  be  carried  to  the 
apex  of  the  root  by  means  of  a  nerve  canal-plugger,  and  the 
crown  cavity  closed  with  a  temporary  stopping.  The  gum 
tissue  about  the  affected  tooth  should  then  be  painted  with 
tincture  of  iodine  and  aconite,  which  will  aid  in  the  reduc- 
tion of  the  inflammation  by  counter-irritation.  This  treat- 
ment should  be  repeated  in  from  two  to  three  days,  and  con- 
tinued according  to  the  character  and  symptoms  of  the  case 

in  hand. 

Ulceration. 

Ulceration  is  an  open  suppurating  surface.  When  ulcera- 
tion is  at  all  deep-seated,  it  differs  from  an  abscess  in  not 
having  a  lining  membrane,  forming  a  sac,  but  involves  the 


DISEASES    OF    THE    DENTAL    PULP    AND    MEMBRANE.  33 

contiguous  structure,  the  pus  passing  through  the  tissue  at  one 
or  several  partings. 

Treatment    consists   in    applying   astringents    and    anti- 
septics, and  administering  a  tonic. 


DISEASES  OF  THE  DENTAL  PULP  AND 
MEMBRANE. 

Inflammation  of  the  Pulp. 

As  in  other  tissues,  inflammation  is  induced  in  the  pulp  by 
irritation.  The  most  frequent  cause  is  the  encroachment  of 
dental  caries;  this  removes  the  normal  covering  of  the  pulp, 
allowing  thermal,  chemical,  and  mechanical  irritation  to 
readily  reach  that  soft  tissue. 

Treatment. — If  irritation  has  been  mild  and  only  for  a 
few  days,  immediate  filling  will  give  relief.  If  the  irritation 
continues  for  several  days,  and  has  been  severe  enough  to  cause 
any  actual  pain,  treatment  consists  in  applying  some  stimulat- 
ing antiseptic  and  filling  with  a  good  temporary  stopping. 
If  no  further  pain  is  felt  within  ten  days,  fill  permanently. 
When  the  irritation  has  continued  for  a  considerable  length  of 
time,  the  pulp  being  seriously  involved  though  it  may  not  be 
exposed,  or  in  cases  where  the  pulp  is  exposed  from  the  dis- 
integration of  the  dentine  covering,  and  is  subject  to  paroxys- 
mal pains,  it  is  generally  preferred  to  devitalize  and  extirpate 
the  pulp  and  fill  the  canals  before  attempting  to  fill  the  crown 
cavity. 

In  teeth  that  are  not  carious,  inflammation  of  the  pulp 
may  arise  from  violent  thermal  changes,  to  which  they  are 
sometimes  very  sensitive,  and  if  repeatedly  exposed  to  such 
changes  death  of  the  entire  pulp  may  be  the  result.  Or 
some  slight  mechanical  injury,  resulting  from  a  fall  or  blow, 


34  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

may  cause  sufficient  congestion  to  cause  death  of  the  pulp. 
Hence,  we  not  infrequently  find  teeth  with  devitalized  pulps 
that  are  otherwise  sound. 

Treatment  in  such  cases  is  very  simple.  If  the  irritation 
is  from  thermal  changes  and  has  not  been  of  long  standing, 
the  pulp  will  return  to  its  normal  condition  by  simply  remov- 
ing the  irritant ;  that  is,  protecting  the  teeth  from  such 
marked  thermal  changes  and  applying  a  good  stimulant, 
such  as  tincture  of  iodine,  to  the  gum  over  the  root  of 
the  tooth  affected.  If  the  pulp  has  been  devitalized  or  the 
irritation  has  continued  for  such  a  length  of  time  as  to  make 
devitalization  necessary, — that  is,  where  it  will  not  respond  to 
the  treatment  just  described, — it  should  be  removed  by  open- 
ing the  tooth  at  a  point  making  the  pulp  chamber  and  canal 
of  most  easy  access;  and  after  the  devitalized  organ  is 
removed  the  canals  should  be  thoroughly  filled. 

Inflammation  of  Pulp  Following  Filling. — Occa- 
sionally inflammation  of  the  pulp  follows  the  filling  of  cari- ' 
ous  teeth.  This  may  arise  from  mechanical  irritation,  that 
is,  undue  pressure  upon  the  pulp  by  the  capping  or  filling 
material ;  chemical,  by  the  action  of  acids  used  in  the  capping 
or  filling  material ;  or  thermal,  by  the  conductibility  of  the 
filling  material,  readily  carrying  every  impression  to  the  pulp. 

Treatment. — This  can  be  readily  diagnosed,  and  when  the 
inflammation  is  only  superficial  the  pulp  may  be  restored  to 
health  by  removing  the  irritant  and  treating  as  directed  above. 
But  when  inflammation  is  more  general  (and  every  precaution 
has  been  taken  in  filling  the  tooth),  there  is  no  reasonable 
probability  that  it  can  be  saved ;  the  filling,  therefore,  should 
be  taken  out,  the  pulp  destroyed  and  removed,  and  the  tooth 
refilled. 

Hypertrophy  of  the  pulp  is  preceded  by  chronic  in- 
flammation.    //  is  the  result  of  caries.     The   nerves  do  not 


DISEASES    OF    THE    DENTAL    PULP    AND    MEMBRANE. 


OD 


retain  the  same  degree  of  growth  as  the  connective  tissue  of 
the  pulp  ;  the  pulp  polypus  is,  therefore,  not  so  painful  as 
the  normal  or  acutely  inflamed  portion  ;  for  this  reason  such 
growths  are  permitted  to  remain  in  the  cavity  for  months 
before  the  patient  calls  for  treatment. 

Treatment  consists  in  the  extirpation  of  the  polypus,  then 
the  devitalization  and  removal  of  the  remainder  of  the  pulp, 
before  filling. 

Pulp  Nodules,  or  Nodular  Dentine. 

Pulp  nodules,  or  nodular  dentine,  is  a  formation  of 
small  nodules  of  calcified  matter  within  the  pulp  cavity;  they 
are  generally  confined  to  the  body  of  the  pulp,  but  at  times 
nodules  are  found  within  the  root  canals.  Since  nodular  calci- 
fications sometimes  occur  in  the  pulps  of  teeth  the  crowns  of 
which  are  perfect,  there  being  neither  abrasion  nor  decay, 
though  decay  may  be,  and  often  is,  found  in  connection  with 
such  formations,  the  presence  of  these  bodies  is  evidently  due 
to  some  other  cause  that  is  as  yet  unknown.  These  bodies 
give  much  trouble  when  connected  with  other  diseases  affect- 
ing the  tooth  pulp,  h\x\.  pain  fro7n  this  cause  alone  is  very  rare. 
When  these  bodies  do  occasion  trouble,  it  is  generally  in  the 
form  of  infra-orbital  neuralgia,  with  paroxysms  of  pain  in  one 
or  more  of  certain  teeth.  Patients  with  these  symptoms  some- 
times present  themselves.  In  these  instances,  where  no  carious 
or  otherwise  visibly  diseased  teeth  are  found,  it  may  be  pre- 
sumed that  the  pain  is  caused  by  an  odontinoid  formation  in 
the  pulp  of  one  of  these  teeth.  To  ascertain  the  affected 
tooth,  the  usual  tests  of  cold  water  and  percussion  should  be 
employed,  when  the  patient  will  usually  express  some  abnormal 
feeling  in  the  tooth  or  teeth  containing  these  formations. 

Treatment. — When  pulp  stones  are  diagnosed,  the  tooth 
should  be  drilled  into,  in  the  best  position  and  direction  for 


7,6  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

reaching  the  pulp;  this  done,  arsenious  acid  should  be  applied 
for  the  devitalization  of  the  pulp,  which,  of  course,  should 
be  thoroughly  removed  and  the  root  canals  and  tooth  filled. 

Gangrene  of  the  Pulp. 

Gangrene  of  the  Pulp  (death  in  a  body  without  loss  of 
substance,  as  in  suppuration). — Gangrene  of  the  pulp  not  in- 
frequently is  the  result  of  acute  inflammation  ;  the  over-supply 
of  blood  in  the  arteries  compresses  the  veins  at  the  dental 
foramen,  almost  or  entirely  interrupting  the  circulation,  thus 
causing  the  death  of  the  pulp  ui  a  body.  Treatment  consists 
in  the  removal  of  all  remnants  of  pulp  and  in  perfect  disin- 
fection of  the  root  canals  before  filling. 

Pericementitis  (inflammation  of  the  pericemental  mem- 
brane) is  consequent  upon  some  one  or  more  of  the  following 
irritants:  inflammation  of  the  pulp,  putrescent  pulp,  excess 
of  filling  material,  looseness  of  the  tooth  or  root,  salivary  or 
sanguinary  calculus,  dental  manipulation,  mal-occlusion, 
want  of  occlusion,  mercurial  poisons,  previous  pericemen- 
titis, etc. 

Symptoms  are  knowledge  of  the  presence  of  the  tooth, 
apparent  elongation  of  the  tooth,  pain  following  pressure  from 
occlusion  of  the  jaws,  from  the  tongue,  fingers,  etc.,  the 
most  decisive  test  being  the  tapping  of  the  tooth,  which, 
under  these  conditions,  is  followed  by  severe  pain. 

Treatment. — First  remove  the  irritants,  vital  or  mechani- 
cal, then  apply  a  good  stimulant  and  sedative  to  the  gum  over 
the  affected  tooth,  to  hasten  resolution.  A  hot  foot-bath  is 
also  beneficial  in  relieving  the  blood  pressure  in  the  diseased 
parts.  When  gangrenous  or  putrescent  pulp  is  diagnosed, 
the  teeth  should  be  thoroughly  opened  up,  every  vestige  of 
the  pulp  removed,  the  canal  roots  thoroughly  cleansed  and 
disinfected  as  soon  as  the  soreness  will  permit. 


DISEASES    OF    THE    DENTAL    PULP   AND    MEMBRANE.  37 

PVORRHCEA    AlVEOLARIS. 

Pyorrhoea  alveolaris  is  a  term  applied  to  a  condition 
characterized  by  a  breaking-down  of  the  alveolar  walls  ;  a 
formation  of  pus  about  the  roots  of  the  teeth  ;  a  deposit  of 
calculi,  either  salivary,  sanguinary,  or  both,  upon  the  teeth  ; 
a  destruction  of  the  pericementum,  inflammation  of  the  sur- 
rounding tissues,  and  accompanied  by  a  general  calcic  diathe- 
sis. This  disease  has  been  divided  by  Professor  Peirce  into 
two  classes  :  (i)  Those  of  local  origin,  and  (2)  those  having 
their  origin  in  a  constitutional  derangement.  In  writing  upon 
this  subject*  Dr.  Peirce  stated  that  in  the  effort  to  reduce  the 
disease  to  the  simplest  factors  and  determine  the  primary  ori- 
gin of  each,  he  should  coin  two  terms,  which  he  thought 
would  be  more  expressive  as  to  the  nature  of  the  disease. 
The  first  form,  where  the  salt  is  deposited  from  the  saliva,  he 
has  designated  as  ptyalogenic  calcic  pericementitis,  expressing 
the  idea  that  in  its  origin  it  is  local,  peripheral,  and  salivary. 
The  second  he  designated  as  hematogenic  pericementitis,  ex- 
pressive of  the  idea  that  in  its  origin  it  is  constitutional, 
central,  and  associated  with  some  modification  of  the  normal 
composition  of  the  blood  plasma.  The  latter,  however,  is  the 
condition  which  may  be  termed  true  pyorrhoea  alveolaris. 
This  latter  form  of  the  disease  has  been  demonstrated  bv  Pro- 
fessor  Peirce  to  usually  accompany  the  gouty  diathesis,  and  he 
has  been  misquoted  by  many  in  that  it  was  the  result  of  gout. 
His  researches,  however,  show  that  it  is  not  the  result  of  this 
disease,  as  it  may  exist  where  there  are  no  marked  symptoms 
of  gout,  but  that  the  predisposing  cause,  uric  acid,  or  other 
waste  products,  are  universally  present.  In  other  words,  it  is 
another  expression  of  the  uric  acid  condition. 

^  For  the  O^ontological  Society  of  New  York,  November,  1893. 


;^S  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

When,  however,  this  catarrhal  condition  of  the  gums  is 
found  to  be  of  local  origin  only,  it  may  be  caused  by  the 
irritation  resulting  from  the  accumulation  of  salivary  calcu- 
lus upon  the  necks  and  roots  of  the  teeth,  or  a  general  lack 
of  oral  hygiene,  or  from  the  non-occlusion  or  mal-occlusion 
of  the  affected  teeth,  or  possibly  from  a  combination  of  these 
conditions. 

Clinical  History. — The  clinical  history  of  pyorrhoea 
alveolaris  is,  as  has  been  previously  indicated,  a  deposition  of 
calcic  matter  upon  the  necks  or  roots  of  the  teeth  ;  a  loosening, 
swelling,  and  more  or  less  inflammatory  condition  of  the  gums; 
an  oozing  of  pus  from  beneath  the  gum  margins;  a  resorption 
of  the  alveolar  borders  ;  and  a  progressive  loosening  and  mal- 
position of  the  afl'ected  teeth. 

Treatment. — In  this,  as  in  all  diseased  conditions,  the 
first  effort  should  be  to  remove  the  cause — that  is,  the  source 
of  irritation.  Where  the  trouble  is  simply  of  a  local  nature, 
local  oral  treatment  is  all  that  is  required.  It  may  be  simply 
the  removal,  by  suitable  scaling  instruments,  of  calcareous 
deposits  from  the  necks  and  roots  of  the  teeth,  followed  with 
local,  astringent,  and  stimulating  treatment  for  the  gums,  and 
enforced  hygienic  treatment  of  the  mouth,  or  if  malocclu- 
sion  or  lack  of  occlusion  play  any  part,  this,  too,  should  be 
corrected,  if  need  be,  by  the  insertion  of  a  sufficient  number 
of  artificial  teeth  to  overcome  the  difficulty ;  or,  if  any  of 
the  teeth  are  very  loose,  as  we  more  frequently  find  the  lower 
incisors,  they  should  be  securely  bound  together  by  some 
light  mechanical  appliance. 

When  the  origin  is  in  a  systemic  derangement, 
which  is  usually  found  to  be  a  uric  acid  diathesis,  the  general 
treatment  is  directed  toward  the  examination  of  waste  pro- 
ducts ;  a  plain,  wholesome  diet  and  open-air  exercise  should 
be  prescribed.     In  such  cases  the  medicinal  treatment  should. 


DISEASES    OF    THE    DENTAL    PULP    AND    MEMBRANE.  39 

as  has  been  indicated,  be  directed  toward  the  elimination  of 
uric  acid  and  its  compounds.  For  this  purpose  some  of  the 
various  lithium  preparations  are  indicated.  The  writer  has 
employed  a  preparation  combining  three  important  alkalies 
— bicarbonate  of  lithium,  potassium,  and  sodium — known  as 
"  alkalithia,"  with  much  satisfaction.  And  as  an  adjunct  has 
prescribed  the  free  use  of  alkaline  waters — Vichy,  Carlsbad, 
Apollinaris,  etc.,  as  was  originally  recommended  by  Prof. 
Peirce.  In  addition  to  the  above  anti-gout  regime,  careful 
and  frequent  local  treatment  should  be  given.  The  roots 
should  be  cleansed  as  thoroughly  as  possible  from  all  calcic 
deposits,  the  pockets  formed  about  the  roots  should  be 
freely  irrigated  with  peroxide  of  hydrogen  in  warm  water, 
followed  by  the  introduction  of  a  few  drops  of  pyrozone, 
25  per  cent.,  or  trichloracetic  acid,  50  per  cent.,  in  each 
pocket.  This  will  "burn  out"  the  pockets,  stimulating  the 
formation  of  new  granulations  ;  then  the  application  of  local 
stimulants,  such  as  the  tincture  of  iodine,  should  be  made  to 
the  surface  of  the  gums,  and  repeated  at  frequent  intervals. 

Dental  Erosion. 

Dental  erosion  is  a  chemical  solution  of  the  faces  of 
teeth,  and  should  not  be  confounded  with  dental  caries  or 
mechanical  abrasion.  The  labial  surfaces  of  the  teeth  are 
usually  attacked,  resulting  in  the  formation  of  cup-shaped 
excavations.  The  erosion,  in  some  cases,  progresses  until 
the  pulp  area  is  encroached  upon ;  in  these  cases,  how- 
ever, it  is  usually  found  that  nature  has  caused  a  deposit  of 
calcic  matter  to  be  made  at  the  periphery  of  this  organ  in 
advance  of  the  progress  of  the  erosion,  so  that  when  the 
pulp  is  reached  it  is  found  to  be  entirely  obliterated  through 
calcification. 

Cause. — Dental  erosion  is  the  result  of  the  action  of  acid 


40  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

secretions  from  the  labial  glands,  caused,  probably,  by  the 
patient  being  of  the  uric  acid  diathesis. 

Treatment. — When  the  solution  has  proceeded  to  any 
depth,  the  cavities  may  be  filled.  At  the  same  time  an  alka- 
line mouth-wash  should  be  persistently  used  to  counteract  the 
acidity  of  the  oral  secretions;  counter-irritants  maybe  ap- 
plied to  the  tissues  surrounding  the  glands,  and  in  some 
cases  the  destruction  of  the  glands  by  the  electric  needle  has 
been  suggested  by  Professor  Brubaker. 

Exostosis. 

Exostosis,  or  hypercementosis,  is  a  disease  common  to  all 
bones,  but  owing  to  the  vascularity  of  the  cementum  of  the 
tooth,  it  is  oftener  found  there  to  a  greater  or  less  degree  than 
in  any  other  part  of  the  osseous  structure.  It  consists  of 
outgrowth  of  new  tissue  from  the  cemental  layer  covering  the 
roots  of  the  teeth.  It  sometimes  takes  the  form  of  prominent 
nodules,  and  again  will  be  found  in  regular  layers  or  masses 
covering  a  large  portion  of  the  cementum. 

The  cause  of  exostosis  is  inflammation  of  the  pericemen- 
tal membrane  (pericementitis),  which  may  be  induced  by 
mal-occlusion,  want  of  occlusion,  shock  from  severe  dental 
operations,  or  other  violence,  such  as  biting  thread — a  habit 
formed  by  many  seamstresses.  Harris,  in  his  "Principles 
and  Practice,"  does  not  agree  with  this  theory,  that  hyper- 
trophy of  the  cementum  is  attributable  to  irritation  of  the 
peridental  membrane,  but  states  ''  that  it  seems  to  be  due  to 
some  constitutional  diathesis."  This  we  can  not  entertain 
without  some  demonstration  ;  at  most,  it  can  only  be  a 
predisposing  cause.  Where  any  of  the  above  conditions 
are  continued  for  any  lengtli  of  time  it  causes  an  abnormal 
energy  in  the  odontoblastic  layer  of  the  cementum,  pro- 
ducing increase  in  the  growth  of  the  structure.     The  alveolus 


DISEASES    OF    THE    HARD    DENTAL    STRUCTURE.  4I 

is  in  many  cases  enlarged  or  absorbed  in  proportion  to  the 
growth  of  cementum,  and  the  patient  experiences  little  or 
no  inconvenience,  but  there  are  often  instances  where  the 
enlargement  of  the  cementum  causes  such  pressure  on  the 
nerves  as  to  give  more  or  less  discomfort,  and  sometimes 
excruciating  pain  ;  at  times,  too,  it  causes  severe  facial  neural- 
gia quite  remote  from  the  seat  of  the  trouble.  It  also  happens 
in  this  way  that  the  roots  of  adjacent  teeth  sometimes  become 
firmly  united. 

Treatment. — If  it  is  possible  to  discover  this  disease  at 
an  early  stage,  the  application  of  a  good  counter  irritant,  such 
as  tincture  of  iodine,  over  the  affected  root  may  interfere  with 
its  progress.  But  where  the  disease  has  established  itself,  the 
extraction  of  the  affected  tooth  or  teeth  is  the  only  available 
treatment. 


DISEASES  OF    THE    HARD    DENTAL  STRUCTURE. 

Dental  Caries. 

Dental  caries  is  the  gradual  softening  and  disintegration 
of  the  tooth  substance,  proceeding  from  the  periphery  toward 
the  pulp.  It  first  appears  as  a  chalky,  opaque  spot  in  the 
enamel  in  which  the  structure  is  loosened  and  gradually 
broken  down. 

In  studying  the  causes  of  any  disease,  it  is  usually 
divided  into  predisposing  and  exciting.  By  "predisposing" 
we  mean  such  causes  as  render  the  system  or  organ  liable  to 
attack,  yet  in  themselves  are  not  sufficient  to  cause  the  dis- 
ease. By  ''exciting"  we  mean  such  causes  as  are  actually 
responsible  for  the  establishment  of  the  disease.  The  etiology 
of  dental  caries  will,  therefore,  be  considered  both  from  the 
predisposing  and  exciting  standpoint. 
4 


42       DENTAL  PATHOLOGY  AND  DENIAL  MEDICINE. 

The  exciting  cause  of  dental  caries  is,  primarily,  an 
acid  condition  of  the  oral  secretions,  which  may  be  the  re- 
sult of  fermentation  of  food  debris,  or  acids  taken  in  the 
food.  After  the  enamel  rods  have  been  broken  down  (decal- 
cified), the  tubuli  of  the  exposed  area  of  dentine  is  invaded 
by,  and  forms  a  habitat  for,  many  varieties  of  micro-organisms. 
The  micro-organisms  active  in  the  destruction  or  de- 
calcification of  tooth  structure  are  :  (i)  Those  of  fermentation 
— the  yeast-plant,  technically  known  as  cryptococcus  cerevi- 
siae  ;  (2)  those  responsible  for  destruction  of  the  dentine — 
the  bacilli  (a  cylindrical  or  rod-like  form  of  bacteria).  These 
micro-organisms  do  not  act  directly  upon  the  dentine,  but  in 
the  act  of  their  ftiiiltiplication, — and  they  multiply  in  a  cavity 
of  decay  by  the  millions, — their  product  is  an  acid,  which,  in 
its  turn,  attacks  and  decalcifies  the  dentine. 

The  predisposing  causes  of  dental  caries  are  numerous, 
and  are  in  nearly  all  cases  due  to  constitutional  or  systemic 
disturbances.  The  character  of  the  structure  of  the  teeth 
regarding  both  the  quality  and  quantity  of  the  several  tissues 
is  an  important  factor;  this  is  well  illustrated  by  the  interglob- 
ular spaces  frequently  met  with  both  in  the  enamel  and  den- 
tine. These  spaces  are  the  result  of  some  systemic  disturbance 
during  the  period  of  calcification  of  the  teeth,  and  later  form 
weak  points,  or  are  predisposing  causes  of  caries.  The  position 
of  the  teeth,  too,  is  often  a  factor  in  the  frequency  of  caries 
in  these  organs  ;  that  is,  whether  they  stand  so  that  all  surfaces 
may  be  readily  cleansed,  or  very  irregularly,  presenting  numer- 
ous surfaces  for  the  lodgment  of  fermentable  substances.  The 
general  tone  of  the  system,  whether  giving  to  these  organs 
their  needed  nourishment,  or  a  nerve  or  blood  supply  of  a 
sluggish  nature,  the  effects  of  illness,  and  the  relation  of 
sex  also  present  certain  predisposing  characteristics. 

Dental  Caries    During    Illness. — In    severe    illness, 


DISEASES    OF    THE    HARD    DENTAL    STRUCTURE.  43 

several  conditions  favor  dental  caries  :  ist,  the  lack  of  nutri- 
tion causes  the  teeth  to  be  less  able  to  resist  destructive  influ- 
ences ;  2d,  the  abnormal  acid  secretion  aids  in  the  destruction 
of  the  tooth  substance  ;  3d,  fermentation  often  progresses 
about  the  tooth  without  hindrance,  on  account  of  the  patient's 
inability  to  keep  the  surface  properly  cleansed. 

Dental  Caries  in  Its  Relation  to  Sex. — In  the  male 
adult  the  conditions  are  more  favorable  than  in  the  female. 
The  male  usually  uses  his  teeth  more  in  mastication,  and  par- 
takes of  sweets  less  frequently  between  meals,  there  being  a 
less  desire  for  saccharine  and  farinaceous  foods.  Particles  of 
food  collecting  about  the  teeth  are  readily  converted  into 
lactic  acid,  thus  becoming   injurious  to  the  tooth  substance. 

M.  Parreidt,  in  writing  upon  this  subject,  says:  — 

*'  The  female  is  also  at  a  disadvantage  during  pregnancy,  at 
which  time  a  large  quantity  of  lime  phosphates  are  essential  to 
the  growth  of  the  foetus,  and  this  supply  is  diverted  from  the 
teeth.  It  is  well  known  that  during  pregnancy  fractures  heal 
less  readily,  because  the  lime  phosphates  are  needed  for  the 
foetus.  If,  in  a  similar  manner,  the  nourishment  of  the  teeth 
is  affected,  as  during  the  healing  of  fractures,  one  may  readily 
conceive  that  their  power  of  resistance  against  unhealthy  influ- 
ences must  be  materially  diminished,  and  the  reactions  of  the 
oral  fluids  during  pregnancy  are  not  infrequently  acid.  Finally, 
in  these  cases,  the  reflex  disturbances  of  digestion  should  be 
considered  also,  for  the  acid  eructations  are  also  injurious  to 
the  teeth." 

The  proximal  surfaces  are  convenient  positions  for  the 
lodgment  of  fermentable  substances  ;  in  consequence,  fully  65 
per  cent,  of  the  first  appearances  of  caries  occur  on  these  sur- 
faces of  the  teeth.  From  the  statistical  examinations  made 
by  the  writer  of  one  hundred  thousand  permanent  teeth, 
dental  caries  may  be  classified  in  the  following  groups:  — 


44 


DENTAL    PAIHOLOGY    AND    DENTAL    MEDICINE. 


Superior  central  incisors, carious 

Inferior       "  " 

Superior  lateral       "  

Inferior        "  "  

Superior  cuspids,      

Inferior        "  

Superior  first  bicuspids,       

Inferior     "  "  

Superior  second  bicuspids, 

Inferior         "  "  

Superior  first  molar, 

Inferior     "  "         

Superior  second  molar, 

Inferior         "  "       

Superior  third  "       

Inferior       "  "       


Per  cent. 

.144 

.006 

.14 

.008 

.07 

.009 

.10 

•03 
.08 
.05 
.16 

.145 

.II 

.12 

.025 

•03 


Relative  Location  of  Dental  Caries. 


Superior  central  incisors, 

"  lateral         " 

"  cuspids,    .    .    . 

"  first  bicuspids, 

"  second     " 

"  first  molars, 

"  second  " 

"  third      " 


Inferior  central  incisors, 
"       lateral       " 
"      cuspids,      .    .    . 
"       first  bicuspids, 
"      second     " 
"       firsl  molars,  .     . 
"      second  "       .    . 
"      third      "        .    . 
Note. — The  above  tables  ar 


Approx. 

95 
94 
98 

93 
92 

35 
20 

04 

Approx. 

99 
98 


95 
91 
91 
30 
16 
02 


La. 

.01 

.01 

.015 

.DC  5 

.005 


La. 
.01 
.02 

•045 

.01 

.005 


Pal. 
.04 

•05 
•C05 


Lin 


Mas. 


.065 

•075 
.61 

•75 

•95 

Mas. 


.08 
.085 
.64 
•78 

•95 


Bhc. 


04 

05 
01 

Buc. 


06 
06 
03 


e  made  without  respect  to  age  or  sex. 


DISEASE^    OF    THE    HAKD    DENTAL    STRUCTURE. 


-tD 


Therapeutics  of  Dental  Caries. — The  most  effective 
treatment  of  caries  consists  in  the  removal  of  the  diseased 
portions  and  the  proper  preparations  of  the  cavity,  followed 
by  a  well-inserted  filling  of  the  least  destructible  substance 
compatible  to  the  tooth  substance.  There  are  exceptional 
cases,  however,  where  decay  does  Hot  extend  into  the  den- 
tine— where  the  tooth  may  be  preserved  by  removing  the 
diseased  parts  with  a  fine  stone,  diamond  disk,  or  diamond 
point,  and  leaving  the  surface  thus  treated  \vell  polished. 

Prophylaxis. — From  the  time  of  the  eruption  of  the 
deciduous  teeth  the  mouth  should  be  kept  scrupulously  clean. 
A  soft  or  medium  brush  and  water  should  be  employed  daily 
after  each  meal,  and  with  a  good  powder  upon  rising  in  the 
morning  and  just  before  retiring  at  night.  Where  the  teeth 
are  so  closely  situated  that  the  brush  cannot  be  w'orked  be- 
tween them,  so  as  to  cleanse  the  proximal  surfaces,  floss  silk 
or  quill  toothpicks  should  be  used  to  remove  any  particles  of 
food  that  become  lodged  between  the  teeth. 

Mouth-washes. — Alkaline  mouth-washes,  such  as  the 
milk  of  magnesia,  lime-water,  or  bicarbonate  of  soda  in  solu- 
tion, are  sometimes  used  ;  not,  however,  as  a  substitute  for 
the  tooth  brush  and  dentifrice,  but  as  an  adjunct.  They  neu- 
tralize the  oral  fluids  when  of  an  acid  reaction. 

Dental  Abrasion. 
Odontalgia  (tooth  pain)  is  not  infrequently  caused  by 
sensitive  dentine  on  the  abraded  or  worn-down  masticating 
surfaces  of  the  teeth  ;  the  enamel  covering  being  removed, 
the  dentine  more  readily  carries  the  irritation  to  the  pulp.  If 
the  irritation  is  very  severe,  and  is  continued  for  a  consider- 
able length  of  time,  it  may  cause  acute  inflanwiatio?i  and  lead 
to  the  death  of  the  pulp.  This  condition,  however,  usually 
shows  itself  when  there  is  a  strong  calcic  diathesis.     That  is, 


40      DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

where  there  is  an  abundance  of  lime  in  the  system,  making 
the  teeth  hard,  and  sometimes  more  or  less  brittle.  Owing 
to  this  abundance  of  lime,  the  pulp,  in  these  cases,  generally 
responds  to  the  irritation  by  throwing  out  a  deposit  of 
secondary  dentine  proportionate  to  the  advance  of  the 
abrasion.  Abrasion,  as  has  been  indicated,  is  a  mechanical 
action,  and  should  not  "be  confounded  with  erosion,  which 
is  the  result  of  a  chemical  action. 

Treatment. — Apply  to  the  abraded  surface  chloride  of 
zinc  crystals,  or  touch  with  nitrate  of  silver,  and  follow,  when 
practicable,  by  building  up  the  surface  with  gold  ;  also  make 
application  of  tincture  of  iodine  to  gum,  as  a  counter-irri- 
tant. 

INJURIES  AND  DISEASES  OF   THE  MAXIL- 
LARY BONES. 

Fractures  of  the  Lower  Jaw. 

Fractures  of  the  lower  jaw  are  usually  the  result  of 
direct  violence,  such  as  a  kick  from  a  horse,  fall  from  a 
height  upon  the  face,  the  unskillful  application  of  the  dental 
*'key  "  and  forceps,  etc.  Professor  Pancoast,  however,  met 
with  a  case  in  which  the  neck  of  the  bone  was  fractured  by  a 
violent  fit  of  coughing.  The  patient  was  nearly  seventy  years 
of  age.* 

The  Most  Frequent  Location. — Fractures  occur  most 
frequently  in  the  neighborhood  of  the  cuspid  tooth,  this  posi- 
tion being  determined  by  the  weakness  of  the  bone  at  this 
point,  in  consequence  of  the  depth  of  the  alveoli. 

Fractures  of  the  alveolus  are  frequently  unavoidable 
during  the  extraction  of  teeth.  The  displacement  of  portions 
of  this  bone,  however,  gives  little  inconvenience,  and  hastens 
the  absorptive  process.     Should  the  fracture  affect  the  alveoli 

*Gross'    "Surgery." 


INJURIES    AND    DISEASES    OF    MAXILLARY    BONES.  47 

of  the  adjoining  teeth,  a  troublesome  exfoliation  may  follow. 
Since  accidents  of  this  kind  are  due  to  the  natural  conforma- 
tion of  the  parts,  legal  proceedings  against  the  operator  for 
this  mishap  are  most  unjust. 

Diagnosis. — Fractures  of  the  lower  jaw  are  readily  recog- 
nized ;  the  regularity  of  the  dental  arch  is  altered,  and  the 
mobility  of  the  fractured  portions  is  shown  when  pressure  is 
applied  to  the  teeth  or  alveolar  process  at  the  site  of  pain. 

Crepitation  is  discernible  during  the  first  week  after 
fracture.  Its  absence,  after  this  time,  is  due  to  formations  of 
granulations  and  of  the  partial  union  of  the  fractured  ends. 

The  gums,  also,  are  usually  lacerated  at  the  point  of  frac- 
ture, accompanied  by  considerable  inflammation  and  swelling. 

Fracture  of  the  ramus  of  the  jaw  is  less  frequent  than 
in  the  body,  and  is  not  so  readily  diagnosed,  as  the  upper 
portion  cannot  be  grasped  with  the  fingers,  and  crepitation  is 
difficult  to  make  out. 

Treatment. — The  appliances  used  for  the  maintenance 
of  the  fractured  portions  in  position  may  be  divided  into  two 
classes :  — 

External  and  internal  to  the  mouth,  though  it  may  be, 
in  a  few  instances,  necessary  to  combine  the  two  methods. 
The  simplest  form  of  apparatus  for  external  use  is  the  ordinary 
four-tailed  bandage  or  sling,  with  a  slit  for  the  chin  to  rest  in 
(Fig.  13).  It  is  made  from  a  piece  of  muslin,  about  a  yard 
in  length  and  two  or  three  inches  broad  ;  this  should  have 
"a  slit  four  inches  long  cut  in  the  centre  of  it,  parallel  to, 
and  an  inch  from,  the  edge.  The  end  of  the  bandage  should 
then  be  split  to  within  a  couple  of  inches  of  the  slit,  thus 
forming  a  four-tailed  bandage,  with  a  hole  in  the  middle. 
The  central  slit  can  be  readily  adapted  to  the  chin,  the 
narrow  portion  going  in  front  of  the  lower  lip,  and  the 
broader  beneath  the  jaw,  and   the  two  tails  corresponding  to 


48 


DENTAT.    PATHOLOGY    AND    DEXTAL    MEDICINE. 


the  lower  part  of  the  bandage  are  then  to  be  carried  over  the 
top  of  the  head,  while  the  others  are  crossed  over  them  and 
tied  round  the  na})e  of  tlie  neck.  The  ends  of  the  two  ban- 
dages may  then  be  knotted  together."  * 

Hamilton  has  devised  a  sling  for  which  he  claims  supe- 
riority;   we  give  it  in  his  own  words:    "The  advantage  of 


Fig. 


this  dressing  over  any  which  I  have  yet  seen  consists  in  its 
capability  to  lift  the  anterior  fragment  vertically,  and  at  the 
same  time  it  is  in  no  danger  of  falling  forward  and  downward 
upon  the  forehead.  If,  as  in  the  case  of  most  other  dressings, 
the  occipital  stay  had  its  attachment  opposite  the  chin,  its 
effect  would  be  to  draw  the  central  fragment  backward.     By 


*  Heath. 


INJURIES    AND    DISEASES    OF    MAXILLARY    BONES. 


49 


using  a  firm  piece  of  leather  as  a  maxillary  band,  and  attach- 
ing the  occipital  stay  above  the  ears,  this  difficulty  is  com- 
pletely obviated  "  (see  Fig.  14). 

The  interdental  splint  is  an  apparatus  used  in  common 
among  dentists  for  an  internal  appliance  in  the  treatment  of 


l-"i("..  14. 

fractured  maxilla.  It  is  usually  made  of  vulcanite  rubber,  and 
gives  very  satisfactory  results.  In  1866,  Mr.  Gunning,  of 
New  York,  gave  a  description  of  this  contrivance  as  then  used 
by  him.* 


*  Nexu  York  Medical  Journal  and  British  Journal  of  Dental  Sciefice. 


50  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Method  of  Making  Single  Interdental  Splint. — Take 
impression  in  wax  or  modeling  compound,  using  as  small  an 
amount  as  will   insure  a  good  impression   of  the  teeth  and 


Fig.   15. 

gums.  An  assistant  should  stand  behind  the  patient  and  hold 
the  broken  bone  as  near  in  place  as  can  be  done  with  any  de- 
gree of  comfort  to  the   patient,  while   the    operator   stands 


Fig.   16. 


directly  in  front  and  takes  impression.  After  the  casts  of  both 
jaws  have  been  secured,  they  should  be  carefully  articulated. 
This  is  done  by  cutting  with  a  small  saw  the  lower  cast  at  the 


INJURIES    AND    DISEASES    OF    MAXILLARY    BONES.  51 

point  or  points  of  fracture,  and  rearranging  the  sections  thus 
made,  so  as  to  bring  the  teeth  into  correct  articulation.  The 
pieces  should  then  be  secured  in  this  position  with  plaster-of- 
Paris,  and  the  two  models  placed  in  an  articulator.  This  is 
well  illustrated  in  Figs.  15  and  16,  the  first  showing  the  con- 
dition of  the  cast  before  using  the  saw,  and  the  latter  the 
condition  after  the  pieces  have  been  brought  together 
to  the  proper  articulation  and  secured  with  plaster.  The 
casts  are  then  covered  with  No.  60  tinfoil;  this  makes  the 
cavities  in  the  splint  a  little  larger  than  the  corresponding 


Fig.  17. 


teeth,  making  it  easily  adjusted,  and  leaves  it  with  a  smooth 
surface.  Use  two  thicknesses  of  base-plate  wax  over  the  tin- 
foil, allowing  it  to  pass  down  a  trifle  below  the  necks  of  the 
teeth.  Flask  and  vulcanize  in  usual  manner  for  rubber  work. 
When  the  fracture  is  of  an  obstinate  vertical  nature,  a 
splint  that  will  enclose  the  teeth  and  gums  of  the  upper  jaw 
as  well  as  the  lower  should  be  used  (see  Fig.  17).  When  the 
proper  treatment  is  employed,  a  cure  is  effected  in  from  six  to 
eight  weeks,  according  to  the  age  and  physical  condition  of 
the  patient. 


52  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Fractures  of  the  upper  jaw  are  less  frequent  and  less 
difticult  of  treatment  than  those  of  the  lower  jaw.  In  recent 
cases  a  simple  replacement  of  the  parts  is  all  that  is  necessary, 
and  occasionally  the  application  of  a  simple  retention  splint 
is  employed. 

Angle's  Method  of  Fixation. — A  more  recent  method 
for  treatment  of  fractures  of  the  maxill?e  is  that  devised  by 
Dr.  E.  H.  Angle,  of  Minneapolis.  And  through  the  doc- 
tor's courtesy  the  writer  is  enabled  to  give  a  description  of  his 
methods  and  appliances.  He  says  :  "  The  methods  used  by 
myself  in  treating  fractures  of  the  maxillae  have  been  so  suc- 
cessful and  so  gratifying  that  it  would  seem  they  approach  for 
efficiency  and  simplicity  more  nearly  the  ideal  than  any  yet 
devised." 

In  order  that  this  system  of  treating  fractures  of  the  maxil- 
lary bones  may  be  more  easily  understood.  Dr.  Angle  has 
divided  them  into  three  classes.  The  first  class  comprises  all 
simple  fractures  in  which  the  teeth  are  good  and  sufficiently 
firm  in  their  attachments  (especially  on  each  side  of  the 
fracture)  to  afford  anchorage  for  the  appliance. 

The  second  class  comprises  all  fractures  where  the  teeth  are 
unsuited,  from  disease  or  any  other  cause,  for  anchorage,  but 
yet  sufficient  to  give  the  correct  articulation  of  the  jaws. 

The  third  class  comprises  all  fractures  where  the  jaws  are 
edentulous.  The  following  cases  treated  by  Dr.  Angle  will 
simply  be  alluded  to  in  this  place  to  illustrate  his  methods  of 
treatment.  For  a  fuller  and  detailed  description  of  his  ap- 
pliances, together  with  that  of  the  interdental  splint,  the 
student  is  referred  to  Richardson's  "  Mechanical  Dentistry," 
seventh  edition. 

The  method  of  treatment  in  Class  No.  i  is  illustrated  in 
the  following  case :  A  young  man  fell  from  a  pile  of  lumber, 
a  distance  of  fifteen  or  twenty  feet,  and,  besides  severe  bruises, 


INJURIES    AND    DISEASES    OF    MAXILLARY    BONES.  53 

suffered  a  simple  fracture  through  the  symphysis,  terminating, 
however,  in  front  between  the  central  and  lateral  on  the  left 


Fig.   18. 


side,  as  shown   by  the  line  in  the  engraving,  Fig.  iS,  which 
shows  the  appliance  used  in  position. 


V^ 


Fig.   19. 

The  treatment  for  cases  of  Class  No.  2  is  illustrated  in 
Fig.  19. 

For  Class  No.  3,  comprising  fractures  of  edentulous  jaws, 
which  are  fortunately  very  rare.  Dr.  Angle's  method  of  treat- 


54  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

ment  is  similar  in  principle  to  that  in  Class  No.  i,  only  that 
in  place  of  the  teeth  small  bone  hooks  are  used,  drilling  for 
their  reception  a  suitable  cavity  on  each  side  of  the  fracture, 
comparing  in  position  to  the  original  sockets  of  the  teeth, 
the  same  as  if  the  operation  of  implanting  teeth  were  in- 
tended, excepting  that  the  cavities  thus  made  need  not  be 
nearly  so  large  or  deep.  They  should  also  be  drilled  obliquely, 
to  correspond  to  the  course  taken  by  the  hooks.  The  hooks 
before  insertion  should,  of  course,  be  made  antiseptic.  While 
Dr.  Angle  has  confidence  in  this  means  of  treatment  for 
edentulous  jaws,  the  writer  should  hesitate  to  employ  it  in 
this  class  of  cases,  as  it  seems  evident  to  him  that  the  inter- 
dental splint,  already  described,  would  be  more  practicable. 

Necrosis  of  the  Jaws. 

Necrosis  of  the  jaw  is  indicated  by  inflammation,  similar 
to  that  of  dental  periostitis.  The  gum  about  the  affected  part 
is  swollen  and  of  a  dark-red  or  purple  color,  pus  oozing  from 
the  edge  of  the  gum  between  the  teeth,  or  through  one  or 
more  fistulous  openings  ;  this  discharge  is  not  always  con- 
fined to  the  mouth  ;  we  find  the  pus  escaping  sometimes 
through  an  opening  on  the  cheek  or  neck,  as  low  down  at 
times  as  the  clavicle. 

The  effect  of  necrosis  of  the  jaw  upon  the  teeth  is 
obvious,  since  great  pain  is  produced  by  the  least  pressure,  and 
in  cases  of  entire  necrosis  they  become  loose  and  discolored ; 
in  the  majority  of  such  cases  the  teeth  prove  such  an  annoy- 
ance to  the  patient  that  they  are  extracted,  if  they  do  not 
drop  out  of  their  own  accord.  Cases  are  met  with,  however, 
where  the  teeth  remain  in  situation  after  the  bone  was  both 
necrosed  and  had  been  removed. 

Treatment. — Remove  the  dead  portions  from  around  the 
living  bone, — here  the  dental  engine  and  burrs  are  useful, — 


INJURIES    AND    DISEASES    OF    MAXILLARY    BONES.  55 

syringe  with  tepid  water  and  peroxide  of  hydrogen  to  cleanse 
the  parts,  followed  by  stimulants,  tonics,  and  nourishing  diet. 

Ne^v  bone  is  produced  in  the  lower  jaw  if  the  periosteum 
is.  preserved,  this  with  the  surrounding  tissue  being  active  in 
producing  new  bone  to  take  the  place  of  the  lost  portion. 

In  the  superior  maxillary  there  is  a  development  of 
fibrous  tissue  in  the  young  subject.  In  the  adult,  nature  does 
not  do  this  much.  When  a  part  of  the  superior  maxillary  is 
necrosed,  the  periosteum  ordinarily  makes  no  effort  to  renew 
the  lost  bone.  (For  an  elaboration  upon  this  subject  see 
Heath's  "  Diseases  of  the  Jaw.") 

Dislocation  of  the  Lower  Jaw. 

The  causes  of  dislocation  of  the  lower  jaw  are  yawning, 
shouting,  vomiting,  the  introduction  of  the  stomach-pump, 
etc.  Sometimes  it  occurs  during  operations  upon  the  teeth  ; 
in  all  cases  the  patient's  mouth  is  opened  to  its  fullest 
extent.  The  capsular  ligament,  being  very  large  and  tena- 
cious, is  not  ruptured. 

The  manner  in  which  dislocation  takes  place  is  as 
follows  :  When  the  mouth  is  opened  to  its  fullest  extent,  each 
condyle  of  the  jaw  leaves  the  true  articular  eminence  of  the 
interarticular  fibro-cartilage,  which  is  drawn  forward  of  the 
external  pterygoid  muscle.  A  cavity  is  thus  left  behind  the 
condyle  ;  when  the  jaw  is  in  this  position,  but  very  slight 
force  is  needed  to  carry  the  condyle  over  the  articular 
eminence,  producing  a  dislocation. 

Symptoms  of  Dislocation. — The  mouth  is  open  and 
the  jaw  fixed,  mastication  being  impossible,  as  the  lower  teeth 
project  beyond  those  of  the  upper  jaw.  Saliva  dribbles  from 
the  mouth,  and  speech  is  indistinct.  A  careful  examination 
reveals  a  concavity  immediately  in  front  of  the  ear,  and  the 
condyle  may  be   both  seen   and   felt  in  front  of  this.     The 


50  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

masseter  muscle  is  firmly  contracted  and  very  prominent  (see 
Fig.  20). 

Treatment. — Reduction  is  made  by  placing  the  thumbs 
(protected  by  napkins)  as  far  back  upon  the  molars  as  pos- 
sible (see  Fig.  21),  depressing  the  back  part  of  the  jaw,  fol- 
lowed at  once  by  the  raising  of  the  chin,  which  results  in 
sliding  the  capitulum  backward  into  the  condyle  fossa.     After 


Fig.  20. — Dislocation  of 
Lower  Jaw. — [Bryant.) 


Fig.  21. — Reduction  of  Dis- 
location OF  Lower  Jaw. — 

[Brya}ii.) 


correcting  the  dislocation  the  jaws  should  be  secured  by  a 
bandage  extending  under  the  chin  and  over  the  top  of  the 
head.  The  patient  should  be  recommended  to  take  care,  for 
some  weeks,  not  to  open  the  mouth  too  far,  as  a  disposition 
to  a  recurrence  is  great. 

Inflammation  of  the  Temporo-maxillary  Articulation. 

Serious  inflammation  of  the  temporo-maxillary  articulation 

is  infrequent;  when  such  complaint  arises,  it  is  usually  found 


INJURIES    AND    DISEASES    OF    MAXILLARY    BONES.  57 

that  some  derangement  of  the  teeth  is  the  seat  of  the  trouble  ; 
however,  when  by  a  close  examination  we  find  the  teeth  and 
their  surrounding  tissues  in  an  apparently  good  condition, 
inflammation  of  this  articulation  may  be  surmised. 

Symptoms. — The  parts  in  the  vicinity  of  the  joint  are 
sensitive  to  pressure ;  they  present  a  swollen  appearance  and 
cause  considerable  pain  when  the  mouth  is  opened  and  closed. 

Treatment. — First,  comparative  rest  must  be  given  the 
joint,  the  patient  partaking  only  of  liquid  or  soft  food.  An 
application  of  some  good  stimulant,  such  as  tincture  of  iodine, 
followed  by  ice-water  compresses,  to  decrease  the  heat  of  the 
inflamed  parts. 

Abscess  of  the  Antrum  of  Highmore. 

The  antrum  of  Highmore  is  separated  from  the  apices  of 
the  superior  molars  by  a  very  thin  lamella  of  bone,  which 
is  sometimes  penetrated  by  the  roots  of  a  tooth,  usually  the 
first  molar.  At  times  the  inflammation  from  alveolar  perios- 
titis extends  to  the  mucous  membrane  of  the  antrum,  but  less 
frequently  does  an  abscess  of  the  alveolar  process  penetrate 
this  membrane  and  discharge  pus  into  the  antrum.  Ab- 
scesses, however,  are  sometimes  formed  in  the  antrum  by  the 
septic  decomposition  of  the  pulp  of  a  tooth  the  roots  of  which 
extend  into  the  cavity. 

When  this  takes  place,  the  natural  opening  between  the 
antrum  and  the  nose  becomes  diminished  by  the  swelling  of 
the  lining  mucous  membrane.  Inflammation  becomes  exces- 
sive, and  a  large  collection  of  pus  takes  place,  which  at  length 
escapes  into  the  nose,  or  burrows  alongside  of  the  root  of  a 
tooth  and  discharges  into  the  mouth.  Or  a  fistula  may  be 
established  upon  the  cheek  ;  and  in  protracted  cases  the  floor 
of  the  orbit  may  give  way,  and  pus  discharge  along  the  lower 
eyelid. 
5 


58  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Symptoms. — Abscess  of  the  antrum  is  indicated  by  a 
discharge  of  pus  into  the  nose,  usually  accompanied  by  a  bad 
odor,  at  times  causing  severe  local  and  constitutional  suffer- 
ing, or  the  pus  may  have  other  outlets,  as  given  above.  The 
cheek  is  hot,  flushed,  and  somewhat  swollen  ;  pain  of  a  throb- 
bing character  is  complained  of;  the  malar  bone  is  elevated, 
with  an  apparent  depression  beneath  it ;  the  palate  in  severe 
cases  loses  its  concavity  and  becomes  convex,  and  the  floor  of 
the  orbit  is  pushed  up,  forcing  the  eye  partly  from  its  normal 
position. 

Treatment. — Free  access  should  be  gained  by  making 
an  opening  into  the  antrum,  either  through  the  process  above 
the  roots  of  the  teeth,  or  by  extracting  the  affected  tooth 
and  entering  by  perforating  the  floor  of  the  antrum  (if  this 
is  not  already  done)  through  the  alveolar  cavity  of  one  of 
the  roots.  The  latter  procedure  is  usually  practised.  After 
this  is  secured,  the  cavity  may  be  cleansed  by  syringing  it 
with  warm  water,  followed  by  dilute  peroxide  of  hydrogen, 
and  bichloride  of  mercury,  i  :  3000,  and  other  stimulating 
and  constitutional  remedies  should  be  applied  as  the  case  may 
indicate. 

During  treatment  a  small  plate  may  be  worn  while 
eating,  to  prevent  particles  of  food  from  entering  the  cavity. 
A  plate  just  large  enough  to  cover  the  cavity,  and  attached  to 
the  adjoining  teeth,  ansv.-ers  the  purpose.  Or  some  temporary 
stopping,  such  as  iodoform  gauze  or  gutta-percha,  may  be 
placed  in  the  cavity. 

DEFECTS  OF  THE  PALATINE  ORGANS. 

Cleft  Palate. — One  of  the  most  distressing  deformities  to 
which  the  human  frame  is  liable  is  that  defective  condition 
of  the  palatine  organs  known  as  Cleft  Palate. 


DEFECTS    OF    THE    PALATINE    ORGANS.  59 

It  is  indicated  by  a  fissure  extending  through  the  soft,  or 
both  the  soft  and  hard,  palate,  causing  an  impairment  of 
mastication,  of  deglutition,  and  of  speech.  They  are  divided 
into  two  classes — Acquired  (by  accident  or  disease),  and 
Congenital  (dating  from  birth). 

Congenital  cleft  palate  is  the  result  of  a  lack  of  de- 
velopment of  the  maxillary  bones,  which  may  be  caused  by 
hereditary  disease,  or  malformation  from  lack  of  nourishment 
of  the  tissues  involved  during  embryonic  life.* 

These  defects  are  sometimes  accompanied  by  more  or  less 
deformity  of  the  alveolar  arch  and  of  the  teeth,  which  are 
usually  of  a  soft  texture,  with  imperfectly  developed  roots. 
The  cleft  is  not  always  confined  to  the  palate  bones  and  the 
soft  palate,  but  may  be  complicated  with  complete  fissure  of 
the  alveolar  process  and  with  harelip. 

Acquired  cleft  palate  includes  all  losses  of  tissue  in 
either  soft  or  hard  palate  that  are  not  congenital,  whether 
occasioned  by  disease  or  accident.  The  faculty  of  distinct 
articulate  speech  is  impaired,  and  deglutition  is  performed 
with  much  inconvenience;  acquired  lesions  coming  generally 
in  adult  life,  the  individual  has  not  the  advantage  of  the 
training  of  the  parts  during  infancy,  as  in  cases  of  congenital 
defects. 

The  infant  resorts  to  a  very  curious  expedient  to  secure  the 
nourishment  necessary  for  subsistence  and  growth.  The  nip- 
ple, instead  of  being  taken  between  the  tongue,  upper  lip,  and 
gum,  is  taken  between  the  lower  surface  of  the  tongue,  and 
the  lower  lip  and  gum.  This  habit  being  acquired,  it  is  ap- 
plied later  in  the  mastication  of  solid  food.  The  food  being 
conveyed  between  the  tongue  and  movable  floor,  is  brought 

*See  article  on  "  Physiology  of  Voice  and  Speech,"  "  American  System 
of  Dentistry,"  Vol.  in. 


6o  DEXTAI,    PATHOLOGY    AND    DENTAL    IMEDICINF. 

back  between  the  teeth  for  deglutition,  which  is  usually  per- 
formed in  this  way  without  any  food  entering  the  nose  through 
the  cleft  palate. 

Treatment. — The  remedy  for  these  deformities  must  be 
the  closing  of  the  passage  in  such  a  way  as  to  restore,  as  far 
as  possible,  to  the  organs,  their  functions.  This  may  be  done 
by  a  surgical  operation  or  by  the  insertion  of  an  artificial 
palate. 

Staphylorrhaphy. 

The  surgical  operation  sometimes  resorted  to  is  an 
exceedingly  painful  one  for  the  patient  and  difficult  for  the 
operator,  and  which,  after  all,  often  proves  a  failure.  Indeed, 
it  is  claimed  by  some  writers  that  failures  of  closure  in  these 
operations  are  in  the  majority.  However  this  may  be,  there 
are  many  cases  on  record  where  such  operations  have  been 
performed  with  a  marked  degree  of  success. 

Staphylorrhaphy  is  derived  from  a  Greek  word  signifying 
suture  of  the  uvula.  It  consists  in  freshening  or  paring  the 
edges  of  the  palate  and  passing  ligatures  or  sutures  through, 
drawing  the  edges  together,  and  closing  the  gap  by  tying  the 
sutures.* 

It  is  claimed  that  the  idea  of  this  operation  was  first  con- 
ceived by  one  Le  Monnier,  an  ingenious  French  dentist,  and 
was  successfully  performed  by  him  as  early  as  1764.  It  does 
not  seem  to  have  been  recognized  by  the  medical  profession 
however,  for  more  than  half  a  century  afterward  ;  it  was  then, 
1820,  practised  by  i\I.  Roux,  in  France,  and  in  America  by 
Dr.  J.  C.  Warren,  of  Boston. 

Dr.  Warren's  methods  were  considered  simpler,  and  his 
operations  are  generally  regarded  as  the  basis  of  the  various 

*  For  fuller  treatment  of  this  operation  see  ' '  American  System  of  Den- 
tistry," Vol.  III. 


EXTRACTION    OF    TEETH.  6 1 

modifications   that  have  since  aided   in   perfecting   the  pro- 
cedure. 

It  is  now  classed  among  the  regular  operations  of  surgery, 
and  the  writer  has  personally  witnessed  and  assisted  in  a 
number  of  such  operations. 

Artificial  Palates. 

Artificial  palates,  according  to  some  writers,  were  em- 
ployed by  the  Greek  physicians,  but  the  first  description  was 
given  by  the  celebrated  French  surgeon,  Ambrose  Pare,  in 
the  early  part  of  the  sixteenth  century.  Many  improvements 
upon  these  primitive  forms  have  been  made.  They  are 
divided  into  two  distinct  classes — obturators  and  artificial 
velum.* 

An  obturator  is  a  non-elastic  and  stationary  cover  or 
stopper  for  those  defects  in  the  hard  or  soft  palate  which  have 
a  complete  and  well-defined  boundary. 

An  artificial  velum  f  is  a  movable  valve,  made  to  supply 
the  loss  of  the  posterior  soft  palate;  being  under  the  control 
of  the  surrounding  muscles,  opening  or  closing  the  passage  at 
will. 

EXTRACTION  OF  TEETH. 

The  extraction  of  teeth  is  an  operation  that  need  sel-- 
dom  be  resorted  to.  It  is,  in  nearly  all  cases,  from  negligence 
of  the  patients  or  their  fear  of  dental  operations  that  the 
teeth  are  permitted  to  remain  in  diseased  conditions  until 
they  reach  such  a  state  that  extraction  is  necessary.  It  is  not 
surprising  that  the  operation  is  usually  approached  with  appre- 
hension, since  frequent  accidents  occur  in  its  performance  ; 

*  See  Richardson's  "  Mechanical  Dentistry,"   seventh  edition. 

I  Velum  :  a  veil,  a  cover  ;   hence,  "  a  pendulous  veil  of  the  palate." 


62  DENTAT,    PATHOLOCV    AND    DENTAL    MEDICINE 

this,  however,  is  generally  due  to  the  neglect,  awkwardness,  or 
unskillfulness  of  the  operator.  It  very  often  occurs  in  the 
hands  of  medical  practitioners,  and  is  a  subject  that  should 
receive  more  attention  from  physicians,  by  whom,  though  not 
belonging  to  their  province,  it  is  frequently  performed.  In 
fact,  if  a  chair  of  dental  pathology  were  established  in  our 
medical  colleges,  it  would  be  a  wise  step  in  the  higher  educa- 
tion of  medical  students. 

Indications  Justifying  the  Operation. — Firsi^  with 
the  teeth  of  first  dentition,  it  is  sufficient  to  state  that  when 
a  tooth  of  replacement  is  about  to  be  erupted,  or  has  actually 
made  its  appearance,  either  in  front  of  or  behind  the  corre- 
sponding deciduous  tooth,  the  latter  should  at  once  be  ex- 
tracted ;  and  when  these  teeth  have  been  so  neglected  that 
they,  together  with  the  surrounding  tissue,  have  become 
seriously  diseased,  it  is  best  that  they  should  be  removed.  It 
is  desirable,  however,  whenever  they  can  be  retained  in  a  fair 
state  of  health,  to  do  so,  retaining  the  shape  of  the  arch  until 
it  is  time  for  their  successors  to  replace  them,  as  well  as  giving 
the  child  their  service  in  mastication. 

Second.  In  regard  to  the  propriety  of  extracting  the  per- 
manent teeth,  it  should  first  be  stated  that  none  of  these 
should  be  sacrificed  unless  called  for  by  some  urgent  necessity. 
Uncontrollable  pain  and  incurable  disease  surrounding  the 
tooth  are  instances. 

Third.  Extensive  loss  of  surrounding  tissue,  leaving  the 
tooth  or  root  very  much  loosened,  acting  as  an  irritant  and 
becoming  a  source  of  disease  to  the  adjacent  parts. 

Fourth.  Where  a  tooth  is  the  cause  of  an  incurable  alve- 
olar abscess,  the  offending  member  should  not  be  allowed  to 
remain  ;  such  cases,  however,  are  rare. 

Fifth.  To  prevent  or  correct  irregularity  in  the  arrange- 
ment of  the  teeth. 


CALCAREOUS    DEPOSITS.  63 

Sixth.  In  preparing  the  mouth  for  an  artificial  denture  it 
is  sometimes  found  that  the  loss  of  one  or  more  remaining 
teeth  may  be  advantageous. 

There  are  other  cases  presented  at  times,  to  which  fixed 
rules  would  not  be  applicable,  where  experienced  judgment 
must  determine  the  practice  to  pursue. 

In  conclusion,  it  is  scarcely  necessary  to  say  tliat  when- 
ever a  tooth  can  be  restored  to  a  healthy  condition  it  should 
always  be  done,  and  that  we  should  not  for  any  reason  be 
too  hasty  in  extracting  the  first  tooth  from  an  unbroken  arch. 
As  all  teeth,  except  the  inferior  central  incisors,  have  nor- 
mally two  antagonists  in  articulation,  the  loss  of  one  tooth 
would  place  two  otliers  partially  without  function,  and  tlie 
adjoining  teeth  would  soon  become  irregular  by  gradually 
leaning  into  the  spaces. 

Hemorrhage  after  Extraction. — In  cases  where  extrac- 
tion is  foliOived  i'}'  excessive  hemorrhage,  or  where  the  tendency 
to  hemorrhage  exists,  the  ap])lication  of  some  reliable  styptic 
should  be  made,  the  following  .being  the  most  powerful  of 
these  agents:  tannic  acid,  gallic  acid,  solution  of  persulphate 
of  iron,  and  the  powdered  subsiilphate  of  iron  (Monsel's 
powder).  Some  of  the  simple  local  remedies  are  spider  web 
or  a  pledget  of  cotton  or  sponge"  saturated  with  sandarach 
varnish  as  mechanical  obstructors ;  this  packing  should  be 
allowed  to  remain  until  all  danger  of  a  return  is  past. 

CALCAREOUS  DEPOSITS. 

There  are  two  varieties  of  calculus,  or  tartar,  as  it  is 
most  commonly  called,  found  upon  the  teeth  ;  namely,  sali- 
vary and  sanguinary. 

Salivary  calculus  is  deposited  from  the  saliva  upon  the 
crowns  or  any   exposed  surfaces  of  the  teeth.     It  varies  in 


64  DENTAL    PAIHOI.OGV    AND    DENTAL    MEDICINE. 

color  from  a  light  cream  to  a  dark  brown  or  black,  depending 
upon  its  age  and  the  habits  and  general  health  of  the  patient. 
The  characteristics  of  the  substance,  therefore,  furnish  diag- 
noses of  importance  to  the  physician  and  dentist. 

Composition. — Salivary  calculus  is  composed  of  mineral 
and  animal  matter ;  about  75  and  25  per  cent,  respectively. 
Phosphate  of  lime,  and  in  some  cases  a  little  magnesia,  car- 
bonate of  lime,  fibrin  or  cartilage,  mucus,  and  a  small  quantity 
of  animal  fat,  are  its  principal  ingredients.  The  relative 
proportions  of  its  constituents  vary  according  to  its  density. 

All  persons  are  subject  to  salivary  calculus  to  a  greater  or 
less  extent,  but  its  physical  characteristics  are  exceedingly 
variable.  Hence  it  is  that  analyses  made  of  it  by  different 
chemists  differ. 

Origin  and  Deposition. — It  is  generally  conceded  that 
this  concretion  is  a  deposit,  chiefly  from  the  saliva,  with  an 
admixture  of  mucus. 

Saliva  is  the  mixed  fluid  from  the  different  salivary  glands 
and  mucous  follicles,  and  in  its  normal  state  is  either  alka- 
line or  neutral.  On  exposure  to  the  atmosphere,  and  the 
decomposition  liable  to  occur  in  the  mouth,  it  may  be  found 
strongly  acid  or  strongly  alkaline,  holding  salts  of  lime  in 
solution.  On  the  formation  of  acids  in  the  mouth,  and  by 
the  action  of  the  carbonic  acid  exhaled,*  decomposition  takes 
place,  and  the  salts  of  lime  are  deposited  upon  the  teeth.  It 
is  precipitated  in  great  quantities  upon  the  surfaces  of  the 
teeth  opposite  the  ducts  from  which  the  saliva  is  emptied, 
upon  the  lingual  surfaces  of  the  inferior  incisors  and  cuspids, 
and  the  buccal  surfaces  of  the  superior  molars.  The  necks  of 
the  teeth  about  the  free  margins  of  the  gum  afford  favorable 

*  Carbonic  acid  having  a  strong  aftinity  for  lime,  unites  with  it  in  the 
salivary  solution,  forming  carbonate  of  lime. 


CALCAREOUS    DEPOSITS.  65 

points  for  its  collection.  A  nucleus  once  being  formed,  it 
deposits  particle  by  particle,  rapidly  encroaching  upon  the 
crown,  where  it  is  deposited  more  abundantly.  In  the  mouths 
of  uncleanly  persons  it  sometimes  accumulates  in  such  quanti- 
ties that  nearly  all  the  teeth  are  encrusted. 

Salivary  calculus  is  not  deposited  upon  the  soft  tissues, 
but  upon  some  substance  that  forms  nuclei,  such  as  the  natural 
and  artificial  teeth,  plates,  etc.  ;  though  it  is  found  sometimes 
in  the  ducts  of  the  salivary  glands,  owing,  no  doubt,  to  a 
sluggish  condition  of  the  saliva. 

Treatment. — The  removal  of  salivary  calculus  is  an  opera- 
tion of  importance  to  the  health  of  the  gums  and  alveolar 
process,  and  the  preservation  of  the  teeth.  For  its  removal, 
instruments  (scalers)  that  may  be  readily'applied  to  every 
part  of  the  tooth  should  be  employed.  Considerable  tact 
and  practice  are  necessary  to  perform  the  operation  skillfully. 
The  scaler  should  be  passed  well  down  beneath  the  margin 
of  the  gums — that  is,  below  the  edge  of  the  deposit — until  it  is 
brought  in  contact  with  the  surface  of  the  tooth,  and  the  mass 
scaled  off  in  the  direction  of  the  cutting  or  masticating  sur- 
face. Every  particle  of  the  deposit  should  be  removed,  care 
being  necessary  that  the  tooth  substance  is  not  roughened  by 
the  edge  of  the  instruments,  and  the  surface  polished,  lest  a 
nuclei  for  immediate  reaccumulation  be  formed. 

Chemical  agents  are  employed  by  some  for  the  removal 
of  salivary  calculus.  This  should  be  scrupulously  avoided,  as 
any  acid  capable  of  dissolving  this  accumulation  is  more  or 
less  injurious  to  the  teeth.  ''  Their  careless  administration  by 
physicians  is  a  fruitful  source  of  injury  to  the  teeth,  and  they 
certainly  should  form  no  part  of  any  dentifrice,  or  be  in  any 
way  used  for  the  removal  of  stains  of  any  kind  from  the  teeth."  * 

*  Harris'  "  Principles  and  Practice  of  Dentistry." 


66  DENTAl.    PATHOLOGY    AND    DENTAL    MEDICINE. 

Sanguinary  calculus  is  deposited  upon  the  roots  of 
the  teeth,  and  not  upon  their  crowns,  as  with  salivary  cal- 
culus. It  is  precipitated  from  the  liquor  sanguinis  of  the 
blood,  upon  its  disorganization,  in  connection  wiih  the  sup- 
purative process  of  inflammation.  It  is  in  the  form  of  dark 
granulations,  approaching  crystaHization.  It  is  much  harder 
than  salivary  calculus,  and  adheres  more  firmly. 

Composition. — Sanguinary  calculus  is  composed  chiefly 
of  lime  salts,  colored  with  the  hgematin  of  the  blood,  which 
increases  its  tendency  to  take  crystalline  form. 

It  should  be  remembered  that  while  salivary  calculus  causes 
inflammation,  sanguinary  calculus  is  a  result  of  the  inflamma- 
tory action. 

Mucous  Deposit. — The  teeth  of  children  are  especially 
liable  to  mucous  deposit,  or  ^' soft  tartar."  It  is  generally 
found  upon  the  labial  surfaces  of  the  superior  front  teeth, 
though  it  is  occasionally  found  upon  the  same  surface  of  the 
inferior  teeth. 

Source. — It  can  readily  be  seen  that  it  is  not  precipitated 
by  the  saliva,  from  its  not  collecting  upon  the  surfaces  of  the 
teeth  opposite  the  mouths  of  any  of  the  ducts  leading  from 
the  salivary  glands.  It  is  generally  considered  to  be  deposited 
from  the  mucus.  It  is  most  abundant  when  the  mucus  is 
secreted  in  large  quantities  and  when  this  secretion  is  in  an 
abnormally  acid  condition. 

Color. — It  varies  in  color  from  a  grayish-brown  to  a  dark 
green. 

The  Effect  of  Mucous  Deposit  upon  the  Teeth. — 
"  This  green  stain  so  erodes  the  enamel  that  decay  advances 
in  the  part  which  it  covers  more  or  less  rapidly,  according  to 
the  quality  of  the  teeth  and  the  length  of  time  it  is  allowed 
to  remain.  The  removal  of  this  mucous  deposit  requires  more 
skillful  manipulation  than  that  of  salivary  calculus,  on  account 


CALCAREOUS    DEPOSITS.  67 

of  its  being  a  thin  film  entering  into  the  substance  of  the 
enamel,  rendering  it  difficult  to  detach  without  injury  to  the 
tooth  substance."  * 

Treatment. — Where  the  erosion  is  but  slight,  this  mucous 
deposit  may  be  removed  by  finely-powdered  pumice  stone  and 
water,  applied  on  a  piece  of  some  hard,  fine-grained  wood, 
such  as  orange  wood,  or  on  wood  points,  rotated  by  means  of 
the  dental  engine,  the  surface  being  left  thoroughly  polished 
or  burnished. 

When  the  effects  are  more  serious,  the  enamel  not 
only  being  discolored,  but  deeply  eroded,  the  use  of  the 
corundum  point,  rotated  by  the  dental  engine,  is  necessary ; 
after  which  the  surface  should  be  left  well  polished. 

*  Harris"  '*  Principles  and   Practice  of  Dentistry." 


DENTAL  MEDICINE. 


Dental  materia  medica  is  an  embodiment  of  the  nature, 
medicinal  properties,  and  therapeutical  action,  of  all  sub- 
stances used  as  medicine  in  dental  practice. 

The  classification  of  medicines  is  made  according  to 
their  action  upon  the  animal  economy. 

The  different  classes  in  common  use  by  dentists 
are  as  follows :  Narcotics  and  hypnotics,  analgesics  or  ano- 
dynes, and  anaesthetics,  stimulants,  tonics,  sedatives,  anti- 
pyretics, irritants,  astringents,  styptics,  and  haemostatics, 
caustics,  escharotics,  antizymotics  or  antiseptics,  and  disin- 
fectants and  laxatives. 


NARCOTICS  AND  HYPNOTICS. 

Narcotics  (stupor)  are  medicinal  substances  which,  by 
impairing  or  destroying  nervous  action,  lessen  the  relationship 
of  the  individual  to  the  external  world.  They  at  first,  how- 
ever, have  a  stimulating  effect,  to  which  their  therapeutic 
efficacy  is  largely  due,  which  is  followed  by  profound  sleep 
and  stupor.  If  the  dose  be  sufficient,  death  will  ensue  by 
paralysis  of  the  centres  of  the  medulla,  wliich  govern  respi- 
ration and  the  other  functions  of  organic  life. 

Hypnotics  (sleep)  belong  to  the  class  of  narcotics,  but 
are  capable  of  causing  sleep  without  any  preliminary  cerebral 

68 


NARCOTICS    AND    HYPNOTICS.  69 

excitement,  by  bringing  the  brain  into  a  favorable  condition 
for  it. 

The  principal  narcotics  are  opium  (see  Anodynes), 
alcohol  (see  Stimulants),  belladonna  (see  Anodynes),  chloro- 
form, ether  (see  Anesthetics),  etc. 

The  hypnotics  are  opium,  the  bromides,  chloral,  etc. 
When  administered  to  relieve  pain,  they  are  termed  anodynes. 

BROMINE,  Br.— BROMIDES. 

Deriviation. — Bromine  is  obtained  from  sea-water  and 
certain  saline  springs. 

Properties. — Bromine  is  a  dark  brownish-red,  liquid, 
non-metallic  element.  It  has  an  offensive,  suffocating  odor, 
somewhat  resembling  chlorine  and  iodine.  In  its  pure  state 
it  is  an  active  escharotic  and  internally  a  violent  poison. 
The  salts  of  bromine  are  cerebral  and  cardiac  depressants 
and  are  highly  valued  as  hypnotics. 

The  Principal  Preparations:  — 

Ammonium  Bromide,  NH^Br. — Colorless,  prismatic 
crystal.      Dose,  gr.  v-xx. 

Calcium  Bromide,  CaBr^. — A  white,  granular,  deliques- 
cent salt.     Dose,  gr.  V-5J. 

Lithium  Bromide,  LiBr. — A  white,  granular,  deliques- 
cent salt.      Dose,  gr.  v-xx. 

Potassium  Bromide,  KBr. — Colorless,  cubical  crystals. 
Dose,  gr.  V-3J. 

Sodium  Bromide,  NaBr. — Colorless,  monoclinic  crys- 
tals.     Dose,  gr.  V-3J. 

Zinc  Bromide,  ZnBr,. — A  white,  granular,  deliquescent 
powder.     Dose,  gr.  ss-ij. 

Syrup  of  Bromide  of  Iron. — Contains  10  per  cent,  of 
ferrous  bromide,  FeBr,.     Dose,  5ss-j. 

Therapeutic  Uses. — The  bromides  are  used  as  sedatives 


70  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

to  the  nervous  system  to  produce  sleep,  and  in  affections  of 
the  heart  or  cerebrum,  when  shown  by  increased  action,  in 
neuralgia,  spasmodic  cough,  etc. 

Dental  Uses. — Bromide  of  potassium  is  a  useful  remedy 
in  convulsions  from  the  irritation  of  dentition,  in  neuralgia, 
also  in  cases  of  extreme  sensitiveness  of  the  soft  palate.  Dose, 
gr.  I0-20  every  hour  for  several  hours  before  taking  impression. 

CHLORAL,  CJlClaO. 

Derivation. — Chloral  is  obtained  by  the  action  of  chlorine 
gas  on  absolute  alcohol.  It  is  a  colorless,  unstable,  oily  fluid, 
which  readily  combines  with  water  and  forms  ch/oral  hydrate , 
the  official  "chloral"   having  the  formula  QHClsOH^O. 

Properties  and  Actions. — The  official  body,  chloral 
hydrate,  is  in  the  form  of  a  white,  crystalline  substance, 
having  a  pungent  odor  and  taste,  and  is  soluble  in  water, 
alcohol,  and  glycerine. 

It  is  hypnotic,  antispasmodic,  and  to  a  limited  degree 
anaesthetic.  It  is  serviceable  in  fevers,  accompanied  by  cere- 
bral excitement,  convulsions,  delirium  tremens,  etc.  Dose, 
from  gr.  v  to  gr.  xxx.  Liebreich  claims  to  have  produced  pro- 
found sleep,  lasting  from  five  to  fifteen  hours,  with  twenty- 
five  to  thirty  grains. 

The  hypnotic  action  is  preceded  by  a  stage  of  excitement 
of  short  duration,  which  is  followed  by  sudden  calm  and 
refreshing  sleep,  from  which  the  patient  can  be  easily  aroused 
to  partake  of  nourishment  and  will  readily  fall  asleep  again — 
differing  in  this  respect  from  narcotism,  which  is  marked  by 
profound  stupor. 

Dental  Use. — Hydrate  of  chloral  is  sometimes  used  in 
dental  practice  for  the  relief  of  odontalgia  from  pulpitis, 
from  one-half  to  one  grain  being  applied  to  the  inflamed 
body.     It  has  also  been  thought  a  serviceable  agent  by  some 


ANALGESICS    OR    ANODYNES.  7I 

in  the  treatment  of  putrescent  pulp-canals,  and  as  a  stimulant 
and  antiseptic  injection  in  chronic  alveolar  abscesses. 


ANALGESICS  OR  ANODYNES. 

Anodynes  are  agents  which  are  capable  of  relieving  pain. 
They  are  divided  into  two  classes,  general  and  local. 

General  anodynes,  when  taken  internally,  affect  the 
whole  organism,  by  depressing  the  cerebral  centres  of  percep- 
tion and  sensation. 

Local  anodynes,  when  applied,  affect  the  parts  either 
by  impairing  the  conductivity  of  the  sensory  nerve-fibres,  or 
by  reducing  the  local  circulation.  Some  of  the  most  efficient 
anodynes  act  either  general  or  local.  The  principal  agents 
of  this  class  are  as  follows  :  — 

General  Anodynes. — Opium,  morphia,  belladonna,  aco- 
nite, ether,  and  chloroform  (see  Anaesthetics). 

Local  Anodynes. — Opium,  belladonna,  carbolic  acid 
(see  Escharotics),  cocaine  (see  Anaesthetics),  aconite,  etc. 

OPIUM. 

Source. — Opium  is  obtained  from  the  white  poppy,  an 
annual  herb  grown  in  Asia  Minor. 

Nature. — It  is  a  gummy  exudatipn  which  follows  the 
incising  of  the  unripe  capsules.  It  should  yield  not  less  than 
nine  per  cent,  of  morphine  when  in  its  normal  moist  condition. 

Opium  contains  seventeen  alkaloids,  the  most  important 
of  these  being  iiwrp/iine — dose,  gr.  2-V~/^ — hypnotic,  narcotic, 
and  anodyne. 

Principal  Preparations  of  Opium: — 

Pulvis  Oipii,  powdered  opium.     Dose,  gr.  ^-ij. 

Tinctura  opii  (laudanum),  composed  of  powdered  opium, 


72  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

oz.  iiss ;  and  diluted  alcohol,  Oj  (pint).  Dose,  n^xij,  or  25 
drops,  equivalent  to  i  gr.  of  opium. 

Tincture  opii  camphorata  (camphorated  tincture  of 
opium,  paregoric)  is  prepared  by  macerating  "sixty  grains 
of  opium  in  two  pints  of  diluted  alcohol,  with  sixty  grains  of 
benzoic  acid,  a  fluidrachm  of  oil  of  anise,  two  ounces  of 
clarified  honey,  and  forty  grains  of  camphor."  Dose,  (^]- 
f5J.  Dose  for  infant,  v  to  xx  drops  (gtt.) — 5SS.  contains 
about  gr.  j.  It  therefore  contains -2^q-  the  strength  of  the  tinc- 
ture. 

Pulvis  ipecacuanhse  et  opii  (Dover's  powder),  com- 
posed of  ipecac  i  part,  opium  i  part,  sugar  of  milk  8  parts, 
triturated  to  a  fine  powder.     Dose,  gr.  v  to  gr.  xv. 


BELLADONNA. 

{Deadly  Nightshade.) 

Source  and  Composition. — It  is  an  European  plant,  the 
leaves  and  root  being  the  medicinal  portions.  It  contains  two 
alkaloids — atropine,  the  active  principle,  and  belladonnine. 

Preparations  of  Belladonna.     From  the  leaves:  — 

Tincture  of  Belladonna. — Dose,  n^^j-^ss. 

Extract  of  Belladonna. — Dose,  gr.  %-%■ 

From  the  root  :  — 

Abstract  of  Belladonna  (powdered). — Dose,  gr.  }i-]4. 

Fluid  Extract  of  Belladonna. — Dose,  y\]-v. 

Sulphate  of  Atropine. — Dose,  gr.  y^o^-eV- 

Therapeutics. — Belladonna  is  especially  useful  in  the 
pain  of  inflammation,  particularly  that  of  rheumatism,  neu- 
ralgia, etc.,  and  is  used  locally  in  connection  with  morphine 
to  relieve  the  pain  of  abscesses,  boils,  etc. 

Atropine  is  used  by  ophthalmologists  to  lessen  pain, 
dilate  the  pupils,  paralyze  the  accommodation,  etc. 


ANALGESICS    OR    ANODYNES.  73 

ACONITE. 

Source  and  Composition. — It  is  obtained  from  the 
tuberous  root  of  Aconituiii  fiapellus,  a  perennial  plant,  found 
in  the  mountainous  regions  of  Europe  and  Asia.  The  leaves 
are  sometimes  used,  but  the  root  makes  the  most  powerful 
drug. 

The  active  principle  is  the  alkaloid  aconitine,  a  sedative 
poison. 

Principal  preparations  :  — 

Extract  of  Aconite. — Dose,  gr.  ^-j. 

Fluid  Extract  of  Aconite, — Dose,  "l/if-U- 

Tincture  Aconite. — Dose,  iTLss-iv. 

Medical  Properties  and  Action. — Aconite  is  a  power- 
ful sedative  to  the  nervous  system.  In  large  doses  it  acts  as  a 
cardiac,  respiratory,  and  spinal  depressant. 

It  proves  fatal  in  poisonous  doses  by  paralyzing  the  heart 
and  respiration.     It  is  also  diaphoretic  and  antipyretic. 

Dental  Therapeutics. — Aconite,  in  the  form  of  a  tinc- 
ture, is  administered  in  inflammatory  affections  and  in  chronic 
cases  of  neuralgia.  It  is  an  active  antagonizer  of  the  fever 
process,  and  has  been  termed  the  "therapeutic  lancet." 

When  applied  locally,  it  checks  inflammation  in  its 
first  stages,  by  paralyzing  the  peripheral  ends  of  the  nerves 
in  the  parts,  and  favoring  resolution  ;  also  limits  the  extent  of 
an  abscess  where  pus  has  already  formed. 

In  combination  with  the  tincture  of  iodine,  in  equal 
parts,  it  acts  very  promptly  in  the  incipient  stages  of  dental 
periostitis,  relieving  the  inflammation,  retarding  the  circula- 
tion, and  stimulating  lymphatic  action. 

In  such  cases  the  gum  over  the  affected  tooth  should  be 
thoroughly  dried  and  then    painted  with    this  combination, 
protecting  the  lip  or  cheek  until  the  remedy  is  absorbed.     It 
6 


74      DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

is  also  considered  useful  by  many  in  the  dressing  of  pulp 
canals,  preventing  the  formation  of  inflammatory  products. 
When  applied  to  a  large  surface,  or  where  the  skin  is  abraded, 
care  should  be  exercised,  or  dangerous  constitutional  effects 
may  result. 

The  physiological  antagonists  are  atropine,  morphine, 
digitalis,  and  ammonia.  In  aconite  poisoning  the  stomach 
should  be  evacuated,  stimulants  administered,  warmth  applied 
to  the  extremities,  and  the  recumbent  position  maintained. 


ANESTHETICS. 

Anaesthetics  are  agents  which  temporarily  destroy  sensa- 
tion and  relieve  pain.  They  are  generally  employed  for  this 
purpose  during  surgical  operations.  They  are  divided  into 
general  and  local  anaesthetics. 

General  anaesthetics  are  volatile  substances,  capable  of 
producing  (when  inhaled)  complete  unconsciousness,  loss  of 
sensibility,  and  lessened  motor  power. 

The  principal  agents  of  this  class  are  ether,  chloro- 
form, nitrous  oxide  gas,  and  bromide  of  ethyl. 

Local  anaesthetics  are  agents  whose  action  is  limited  to 
the  circumscribed  parts  to  which  they  are  applied.  They 
paralyze  the  nerves  of  the  part,  thus  temporarily  destroying 
sensation.  They  act  similarly  to  the  local  anodynes,  except 
that  while  the  anodynes  diminish  the  sensibility  of  the  parts, 
the  local  anaesthetic  destroys  sensation  entirely  for  a  time. 

The  principal  agents  of  this  class  are  cocaine,  abso- 
lute ether,  aconite,  atropine,  etc. 

yETHER— ETHER,  C^HjoO. 
Derivation. — Sulphuric    ether    (improperly  so  called)  is 
ethylic  ether,  or  oxide  of  ethyl.     It  is  obtained  by  the  dis- 


AN/ESTHETICS.  75 

tillation  of  ethylic  alcohol  and  sulphuric  acid,  the  acid  dehy- 
drating the  alcohol  and  remaining  in  the  retort.  (C2H60)2 — 
H.,0  =  QHioO. 

Medicinal  Properties  and  Actions. — Ether  is  a  color- 
less, volatile,  and  inflammable  liquid.  It  is  an  anaesthetic 
and  anodyne,  a  diffusible  stimulant,  and  a  narcotic  poison. 
Administered  internally,  it  is  one  of  the  most  powerful 
secretion  stimulants  known.  The  action  of  the  heart,  and 
hence  the  circulation,  is  increased,  flushing  and  warmth  of 
the  surface  soon  follow.  The  senses  are  more  keen,  and  the 
phenomenon  of  alcoholic  intoxication  results,  which  is  less 
protracted,  however,  ether  being  quickly  eliminated,  chiefly 
by  the  lungs. 

Principal  Preparations:  — 

./Ether  Fortior,  stronger  ether,  ethyl  oxide,  "C4H10O," 
contains  about  six  per  cent,  of  alcohol. 

Sulphuric  Ether,  ethyl  sulphate,  C4H10SO4. 

Nitrous  Ether,  ethyl  nitrite  (sweet  spirit  of  nitre), 
C0H5NO2.  The  well-known  antipyretic  and  diaphoretic. 
Dose,  in^v-3ij. 

Dental  Use. — Ether  is  employed  as  a  general  and  local 
anaesthetic,  as  a  local  anodyne  in  neuralgia  and  odontalgia, 
and  as  a  counter-irritant,  evaporation  being  prevented. 

Ether  as  an  Anaesthetic  Agent. — The  practicability  of 
producing  anaesthesia  by  the  inhalation  of  ether  was  first 
demonstrated  by  Dr.  Horace  Wells,  of  Hartford,  Conn.,  and 
Dr.  AV.  G.  S.  Morton,  of  Boston,  Mass.,  during  the  years 
1844-46. 

Ether,  though  less  prompt  in  its  action,  is  much  safer  than 
chloroform.  It  has  its  necrology,  however;  a  number  of 
fatal  cases  (about  thirty)  have  been  reported. 

The  Administration  of  Ether. — The  operator  should 
be  well  assured,  before  administering  an  anaesthetic,  that  the 


76  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

patient  is  not  laboring  under  any  serious  disease  of  the  heart, 
brain,  or  lungs,  as  ignorance  in  this  direction  might  lead  to 
fatal  results.  The  clothing  about  the  neck  and  chest  should 
always  be  loose,  lest  it  act  as  an  impediment  to  respiration, 
and  if  artificial  teeth  be  worn,  they  should  be  removed  before 
the  administration  of  the  anaesthetic. 

For  the  inhalation  of  ether  and  chloroform  a  num- 
ber of  instruments  have  been  devised,  but  the  simplest  and 
probably  the  best  method  is  from  a  sponge,  napkin,  or  hand- 
kerchief, placed  within  a  cone,  formed  of  a  towel  or  stiff 
paper,  with  a  small  opening  at  the  apex  for  the  admission  of 
air;  or  a  small  piece  of  lint  can  be  held  in  the  palm  of  the 
hand  and  on  tliese  pour  the  anaesthetic  agent. 

The  inhalation  should  be  commenced  cautiously,  the 
patient  should  be  directed  to  breathe  quite  naturally,  and  to 
obey  any  instructions  given,  as  the  raising  of  the  hand,  etc. 
The  towel  or  napkin  should  be  held  three  or  four  inches  from 
the  patient's  face,  approaching  it  gradually,  thus  overcoming 
the  irritating  effect  and  a  sense  of  strangulation,  which 
follow  when  the  agent  is  placed  at  once  to  the  mouth  and 
nostrils. 

Action  of  ether. — The  first  stage  of  anaesthesia  is  a  slight 
relaxation,  the  second  is  tetanic  or  convulsive,  the  third,  com- 
plete relaxation. 

During  complete  anaesthesia  the  face  is  cool,  there 
being  a  profuse  perspiration ;  the  eyes  are  closed,  insensible 
to  the  touch,  and  the  pupils  are  somewhat  contracted.  The 
respiration  and  pulse  are  somewhat  slower  tlian  normal,  as 
shown  in  the  following  table  :  — 

Normal  pulse,  72  a  minute. 

Pulse  on  administration  of  ether:  — 

ist  mill.  2d  mill.  3d  miii.  4th  min.  5lh  miii. 

92  109  no  94  69 


ANitSTHETICS.  77 

Normal  respiratory  movements  average  about  20  a 
minute. 

Respiration  on  administration  of  ether  : — 

1st  mill.  2d  mill.  3cl  miri.  4th  miii.  5lh  miii. 

23  24  26  18  15 

Order  in  which  Nerve  Centres  are  Acted  Upon. — 

First,  the  cerebrum;  second,  cerebellum;  third,  the  spinal 
cord  ;   fourth,  the  medulla  oblongata. 

The  Quantity  of  Ether  Required. — Largest  quantity, 
9  ozs.  ;  minimum,  2JE^  ozs.  ;  average  quantity  to  produce 
an?e>thesia,  5  ozs. 

The  Time  Required  for  Full  Anaesthesia. — Longest 
time  reqtiired,  24  minutes;  shortest  time,  -^jj  minutes;  aver- 
age time,  S  minutes. 

The  Dangers  of  Anaesthesia. — There  are  conditions 
rendering  general  anaesthesia  dangerous,  and  the  practitioner, 
whether  medical  or  dental,  should  be  well  assured,  before 
administering  ether  or  chloroform,  that  none  of  these  are 
present.  They  are  fatty  degeneration  of  the  heart,  valvular 
lesions,  kidney  disease,  brain  tumors,  respiratory  obstructions 
from  enlarged  tonsils,  thoracic  tumors  or  aneurism,  and 
chronic  alcoholism.  An  anaesthetic  should  never  be  admin- 
istered on  a  full  stomach,  as  'sickness  would  likely  follow  that 
would  interfere  with  the  operation,  and  anaesthesia  of  the 
glottis  prevents  the  expulsion  of  vomited  matter  in  case  it 
enters  the  larynx  by  regurgitation  ;  neither  should  it  be  given 
after  long  fasting,  as  an  absence  of  nutrition  would  tend 
toward  cardiac  paralysis;  excitement  should  be  avoided,  in- 
struments should  be  kept  out  of  sight,  and  too  many  spec- 
tators should  not  be  present.  A  painful  operation  should 
not  be  commenced  before  the  stage  of  complete  anaesthesia 
is  reached,  or  it  may  cause  death  from  shock,  as  the  result 
of  peripheral  irritation. 


78  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Treatment  of  Dangerous  Symptoms. — In  case  of 
the  suspension  of  the  heart's  action,  the  agent  should  be 
withdrawn,  the  body  placed  in  a  reclining  position,  and,  if 
need  be,  inverted,  and  air  freely  admitted.  The  failure  of 
respiration  requires  the  drawing  forward  of  the  tongue,  by  a 
finger  being  thrust  deeply  into  the  mouth ;  the  inhalation  of 
a  good  stimulant,  nitrite  of  amyl,  gtt.  ij  to  gtt.  v;  but  care  is 
necessary  in  its  use,  and  not  more  than  two  or  three  drops 
should  be  administered  to  patients  who  have  never  inhaled  it. 
The  inhalation  of  ammonia  is  probably  as  efficient,  and  can 
be  used  with  more  freedom  than  nitrite  of  amyl.  Galvanism, 
too,  has  been  successfully  employed  as  a  cardiac  and  respira- 
tory stimulant,  "  the  positive  pole  being  placed  to  the  nos- 
tril and  the  negative  pole  over  the  diaphragm,  to  excite  a 
reflex  action  between  the  fifth  pair  and  the  pneumogastric,  or 
the  poles  may  be  applied  directly  over  both  phrenic  nerves,  or 
on  a  line  with  the  fourth  cervical  vertebra,  in  order  to  stimu- 
late respirations ;  or  one  pole  may  be  placed  over  the  upper 
dorsal  spinous  process  and  the  other  pole  over  the  apex  of  the 
heart,  to  induce  cardiac  contraction."*  And  if  necessary, 
artificial  respiration  should  be  employed  (see  Appendix)  and 
warmth  applied.  The  extremities  should  also  be  rubbed 
briskly,  rubbing  upward. 

Note. — It  should  be  remembered  that  ether  vapor  is 
heavier  than  air,  and  forms  therewith  a  highly  explosive 
mixture.  Therefore,  if  a  light  must  be  in  the  room,  it  should 
be  high  above  the  patient.  A  grate  fire,  gas  stove,  etc.,  in 
the  vicinity  are  very  dangerous. 

*  Gorgas'  "  Dental  Medicine." 


ANAESTHETICS.  79 

CHLOROFORM,  CHCI3. 

Derivation. — Chloroform  (Ter-cliloride  of  Methyl,  or 
Methylic  Ether)  is  obtained  by  distilling  alcohol  with  chlo- 
rinated lime.  It  was  discovered  in  1831,  by  Samuel  Guthrie, 
of  Sackett's  Harbor,  N.  Y. 

The  form  for  medicinal  use  is  Chloroformum  Purifica- 
tum,  or  Purified  Chloroform. 

Medicinal  Properties  and  Action. — When  inhaled, 
chloroform  is  an  anaesthetic,  and  when  administered  inter- 
nally, it  is  an  anodyne  and  antispasmodic.  If  swallowed  un- 
diluted, it  excites  great  inflammation  of  the  mucous  mem- 
brane and  causes  violent  gastritis. 

Its  effects  are  similar  to  those  of  ether,  but  more  rapidly 
produced,  and  it  is  more  powerful  in  its  action ;  hence, 
requiring  more  care  in  its  administration. 

When  first  administered  (internally)  it  causes  a  feeling 
of  warmth  in  the  stomach,  which  is  soon  followed  by  a  sense 
of  coldness.  It  increases  the  action  of  tlie  heart,  producing 
excitement  of  the  brain,  followed  by  dei)ression  and  deep, 
heavy  sleep.  In  large  doses  it  causes  stupor  and  insensibility, 
and  has  caused  death. 

Therapeutic  Uses. — Chloroform  is  used  for  the  same 
purposes  as  is  ether,  and  is  much  employed  locally  in  lini- 
ments. Administered  by  inhalation,  it  is  a  general  anaes- 
thetic, and  when  administered  internally,  in  substance,  it  is 
an  anodyne  and  antispasmodic,  and  is  used  as  such  in  cases 
of  nausea,  sea  sickness,  sick  headache,  and  in  cases  of 
cholera.  In  the  last  named  it  has  probably  proven  more 
efficacious  than  any  other  single  remedy.  Dose,  n\^  j-^ss, 
diluted,  internally. 

Spirit  of  chloroform  (chloroform,  Bj ;  diluted  alcohol, 
§ij),  5SS-3J. 


So  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

For  inhalation,  3J-5J.     Average,  3iij. 

Dental  Use. — Chloroform  is  employed  by  some  in  dental 
practice  as  a  general  angesthetic  ;  its  use,  however,  is  growing 
less  every  year,  in  favor  of  ether  and  nitrous  oxide  gas.  It  is 
also  used  as  a  local  anaesthetic;  in  this  case  it  is  generally 
combined  with  other  substances,  as  aconite,  alcohol,  ether, 
opium,  etc. 

For  administration  as  an  anaesthetic,  treatment  of 
dangerous  symptoms,  etc.,  see  Ether. 

Chloroform  Narcosis. — 

Shortest  time, 2  minutes  30  seconds. 

Longest  time, 14       "        30        " 

Average  time,  6       "        24        " 

Chloroform  mortality  is  i  in  3000  (over  500  fatal  cases 
are  reported,  none  of  which  were  in  obstetrical  practice). 
Compared  with  ether  mortality,  i  in  16,000. 

NITROUS  OXIDE  GAS,  NjO. 

History. — Nitrous  Oxide,  or  "Laughing"  Gas,  was  dis- 
covered by  Dr.  Priestly  in  1776,  and  its  respirability  demon- 
strated by  Sir  Humphry  Davy,  though  the  results  were  not 
published  until  some  twenty  years  afterward.  In  1844  Dr. 
Horace  Wells  practically  demonstrated  the  value  of  its 
anaesthetic  property  for  the  relief  of  pain  during  surgical  or 
dental  operations. 

Nitrous  oxide  gas  is  manufactured  by  slowly  melting 
and  boiling  the  salt  nitrate  of  ammonia  in  a  glass  retort, 
dissolving  it  into  a  vapor  of  water  and  a  permanent  gas 
(NH,N03  +  Heat=zN20  + 2H.,0).  The  gas  should  pass 
through  three  wash  bottles,  the  first  containing  a  solution  of 
the  sulphate  of  iron  or  caustic  potash,  and  the  other  two 
pure  water,  for  the  purpose  of  purifying  it  before  it  enters  the 
receiver,  from  which  it  is  administered  to  the  patient  through 


ANESTHETICS.  8 1 

an  inhaling  tube.  A  pound  of  the  salt  will  generate  about 
thirty  gallons  of  the  gas.  It  is  perfectly  fused  at  226°  F., 
white  fumes  are  emitted  at  302°  F.,  and  gas  begins  to  evolve 
at  460  F.  If  the  temperature  is  raised  to  500°  F.,  a  danger- 
ous impurity,  nitric  oxide,  is  given  off;  this  need  not  be 
generated,  however,  if  the  proper  care  is  observed,  not  allow- 
ing the  temperature  to  rise  above  480°  F. 

Liquefied  Nitrous  Oxide. — The  most  convenient  form 
for  use  is  the  liquefied  gas,  it  being  liquefied  and  solidified 
under  intense  cold  and  great  pressure  (50  atmospheres,  or  750 
pounds  pressure).  It  is  then  secured  in  strong  iron  cylinders, 
from  which  it  is  allowed  to  escape  into  an  inhaling  bag  when 
needed  for  use. 

The  advantages  of  this  form  of  gas  are  its  purity, 
convenience  for  use,  the  large  supply  which  can  be  kept  on 
hand,  and  its  comparative  freedom  from  deterioration,  not- 
withstanding its  age. 

Properties  and  Actions. — Nitrous  oxide  gas  is  an  elas- 
tic, colorless  gas,  with  a  very  slight  and  agreeable  odor.  It 
will  freeze  into  a  beautiful,  clear,  crystalline  solid,  at  about 
15°  F.  below  zero. 

'^  By  the  evaporation  of  this  solid,  a  degree  of  cold  may 
be  produced  far  below  that  of  carbonic  acid  bath  in  vacuo,  or 
lower  than  17°  F."  * 

Nitrous  oxide  gas  supports  combustion  with  nearly  the 
same  promptness  as  oxygen. 

As  an  Anaesthetic. — Nitrous  oxide  gas  is  the  most 
pleasant  and  the  safest  general  anaesthetic  known.  The  short- 
ness of  the  anaesthetic  stage  is  the  greatest  objection  to  its 
administration  for  surgical  operations,  though  its  rapid  action, 
comparative  safety,  and  the  transient  nature  of  its  effects  on 


*Gorgas'    "Dental  Medicine." 


82  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

the  system  render  it  the  most  useful  anaesthetic  agent  for  all 
minor  operations,  such  as  the  extracting  of  teeth,  removal  of 
nerves  from  the  teeth,  where  the  tooth  substance  is  lost  to  such 
an  extent  that  a  devitalizing  agent  could  not  be  retained,  for 
the  lancing  of  abscesses,  etc. 

The  Administration  of  Nitrous  Oxide  Gas,  for 
dental  operations,  should  be  conducted  with  the  same  care 
that  is  given  to  ether  and  chloroform,  though  it  is  a  compara- 
tively safe  anaesthetic.  The  patient  should  be  seated  in  an 
operating  chair  which  will  admit  of  the  back  being  lowered 
to  such  a  degree  that  the  patient  could  at  once  be  placed  in  ^ 
horizontal  position.  The  dress  about  the  throat  and  waist,  if 
tight,  should  be  previously  loosened,  and  the  patient  should 
not  have  partaken  of  food  for  at  least  two  hours  previous  to 
the  inhalation  of  the  gas. 

A  mouth  prop,  of  which  there  are  several  patterns  manu- 
factured, should  be  placed  between  the  teeth,  to  prevent  the 
closure  of  the  jaws,  as  the  muscles  become  rigidly  contracted 
during  the  administration  of  this  gas.  The  most  suitable  prop 
is  one  made  of  India  rubber — the  ordinary  lead-pencil  eraser, 
cut  in  proper  lengths,  answers  the  purpose  very  nicely — or  a 
firm  cork,  as  it  prevents  injury  to  the  teeth  or  fillings,  as 
sometimes  occurs  when  a  mouth  prop  of  some  hard  substance 
is  used.  The  patient  is  then  directed  to  take  full,  regular,  and 
deep  inspirations  of  the  gas,  the  nose  being  held  or  covered, 
to  prevent  the  admixture  of  atmospheric  air.  Its  anaesthetic 
effects  are  soon  made  manifest  by  strong,  involuntary  respira- 
tions, accompanied  by  snoring,  this  being  caused  by  the 
relaxation  of  the  muscles  of  the  pharynx,  and  paralysis  of  the 
tongue,  causing  it  to  fall  back  toward  the  throat,  interfering 
with  breathing,  and  a  livid  appearance  of  the  lips,  cheeks,  and 
finger  nails,  which  is  due  to  the  discolored  blood  in  the  capil- 
laries.    But  the  most  delicate  test  for  complete  anaesthesia  is, 


ANAESTHETICS.  83 

as  in  ether  and  chloroform,  the  loss  of  sensibility  to  the  touch 
in  the  conjunctiva  of  the  eye. 

The  amount  of  gas  required  to  produce  complete 
anaesthesia  varies,  from  five  to  fifteen  gallons  being  the 
usual  amount.  Out  of  3000  administrations  the  writer  has 
had  one  case  where  65  gallons  were  required,  and  another 
where  80  gallons  were  inhaled  before  the  anaesthetic  stage 
was  reached. 

The  first  stage  under  nitrous  oxide  gas  is  muscular 
activity. 

The  second  stage  is  muscular  rigidity.  It  can  not  be 
continued  until  complete  muscular  relaxation,  lest  the  patient 
die  of  asphyxia. 

Nitrous  Oxide  Gas  Mortality. — There  is  about  one 
death  to  each  125,000  administrations. 

Dangerous  Symptoms,  with  Treatment,  etc. — See 
Ether. 

BROMIDE  OF  ETHYL,  C^H-Br. 

Derivation. — Bromide  of  ethyl,  or  hydrobromic  ether, 
is  obtained  by  distilling  bromide  of  potassium  and  sulphuric 
ether,  and  redistilling  with  chloride  of  lime. 

Properties. — It  is  a  colorless,  volatile  fluid,  possessing  an 
agreeable  ethereal  odor  and  a  pungent  taste.  It  is  not  in- 
flammable, caustic,  nor  irritant;  in  this  respect  it  is  preferable 
to  chloroform  or  ether  as  an  anaesthetic  agent. 

The  Administration. — Bromide  of  ethyl  is  administered 
as  is  ether  or  chloroform,  or  in  a  folded  starched  napkin,  so 
as  to  cover  the  face,  as  directed  by  Prof.  Gorgas.  A  soft 
linen  handkerchief  is  placed  inside  the  napkin,  and  upon  this 
the  agent  is  poured  ;  one  drachm  should  be  used  at  first, 
directing  the  patient  to  take  deep,  full  inspirations.  At  the 
end  of  two  minutes  the  second  drachm  should  be  added  ;  this 
should  be  repeated  at  intervals  of  two  minutes,  until  complete 


84  DENTAL    PATHOLOGY   AND    DENTAL   MEDICINE. 

anaesthesia  is  produced.     The  quantity  differs  according  to 
the  susceptibility  of  the  patient. 

Action. — The  administration  of  bromide  of  ethyl  is  at- 
tended with  some  danger,  and  clinical  experience  has  not 
demonstrated  to  careful  operators  that  it  is  as  safe  as  some 
other  and  older  agents  of  this  class.  It  has  a  toxic  action  on 
the  centres  of  respiration.  The  heart  force  is  decreased  and 
its  action  is  more  frequent,  which  contributes  to  the  paralysis 
of  the  respiratory  centres.  Several  deaths  occurred  in  a  very 
limited  number  of  administrations  of  this  agent. 

COCAINE. 

Source. — Cocaine  is  the  active  crystalline  alkaloid  of  Ery- 
throxylon  coca,  a  small  Peruvian  shrub.  The  leaves  resemble 
those  of  Chinese  tea,  and  in  South  America  they  are  used  by 
eight  millions  of  people  much  as  we  use  tea  or  coffee. 

In  the  preparation  of  the  alkaloid,  it  is  necessary  that 
the  leaves  be  carefully  gathered,  as  the  best  quality  only 
should  be  used.  They  should  be  dried,  and  not  injured  by 
age  or  exposure  to  the  air,  as  moisture  deprives  them  of  value. 

Preparations  of  Erythroxylon  : — 

Extractum  Erythroxyli  Fluidum,  fluid  extract  of 
erythroxylon.     Dose,  3ss-ij. 

Salts  of  cocaine. 

Cocaine  Hydrochlorate,  Cj^H^iNOi. — Dose  internally, 
gr.  j^-ij ;  most  commonly  used  as  a  local  anaesthetic  in 
aqueous  solutions,  2-5  per  cent. 

Cocaine  Oleate,  cocaine  and  oleic  acid,  5-20  per  cent. 
solutions  for  external  use. 

Cocaine  Hydrobromate,  cocaine  and  hydrobromic  acid, 
2-10  per  cent,  as  a  local  anaesthetic. 

Cocaine  Wines,  Pastes,  Lozenges,  etc.,  are  made  in 
great  varieties. 


ANESTHETICS.  85 

Medicinal  Properties  and  Action. — Cocaine,  when 
applied  locally,  acts  as  an  anaesthetic ;  when  taken  internally 
in  small  doses,  it  is  a  general  stimulant,  improving  digestion, 
stimulating  the  respiration,  circulation,  etc.  It  produces 
wakefulness  and  a  marked  diminution  of  the  sense  of  fatigue 
and  hunger.  For  this  reason  the  leaves  are  chewed  by  the 
Peruvian  Indians  to  sustain  them  during  long  journeys  or 
arduous  labor. 

A  toxic  dose,  or  long-continued  use  (cocaine  habit)  pro- 
duces insomnia,  decay  of  the  moral  and  intellectual  powers, 
hallucinations,  insanity,  and  death. 

Dental  Use. — The  salts  of  cocaine  have  proven  very 
efficient  for  their  local  anaesthetic  and  anodyne  effects;  their 
power  as  a  local  anaesthetic  is  very  great  over  a  limited  area, 
and  hence  it  is  of  special  value  to  the  dentist,  for  operations 
upon  the  submucous  tissues  and  the  extraction  of  teeth,  where 
it  should  be  used. by  hypodermic  injection,  or  applied  to  the 
gum  on  either  side  of  the  tooth  to  be  extracted,  the  latter 
method  being  the  safer;  two  or  three  applications  should  be 
made  at  intervals  of  about  two  minutes  each,  when  a  painless 
operation  is  generally  secured.  I  have  found  it  to  act  very 
happily,  also,  in  connection  with  arsenious  acid,  for  the  devi- 
talization of  dental  pulps,  the  pulp  dying  without  giving  the 
patient  any  discomfort.  But  as  for  its  use  as  a  pain  obtundent 
in  hypersensitive  dentine,  its  practical  benefits  are  question- 
able. 

A  warning,  however,  should  be  given,  that  a  potency  for 
evil  lurks  in  this  most  valuable  drug.  In  many  cases  where  it 
has  been  injected  into  the  gum  tissue  for  extraction  of  teeth, 
toxic  results  of  an  alarming  nature  have  occurred  and  patients 
have  been  rendered  ill  for  several  weeks.  This,  however,  is 
not  apt  to  follow  when  the  patient  is  of  a  sanguine  tempera- 
ment and  in  good  health.     I  have  made  a  record  of  many 


S6  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

cases  where  toxic  results  have  followed  the  use  of  this  drug, 
and  find  them  all  to  be  of  a  nervous  or  hysterical  tempera- 
ment, or  pregnant  women.  The  lesson  is  that  we  should  use 
judgment  and  discrimination  in  its  application. 

Dangerous  Symptoms. — The  extremities  usually  become 
cold  and  rigid,  the  eyes  staring  and  glassy,  and  the  face  pallid, 
while  the  pulse  is  weak,  the  heart  beats  faint,  and  respiration 
slow  and  weak — the  symptoms  of  an  impending  collapse. 

Treatment  of  Dangerous  Symptoms. — Fresh  air 
should  be  admitted  and  some  good  stimulant  administered, 
such  as  brandy,  or  aromatic  ammonia  and  nitrite  of  amyl — 
by  inhalation,  or  ether  in  case  of  convulsions,  and  if  need  be 
the  battery.  As  soon  as  the  patient  is  able,  assist  him  to  stand 
up  and  promenade. 

CHLORIDE  OF  ETHYL,  C^H-Cl. 

Properties. — Chloride  of  ethyl  is  a  colorless  liquid  pos- 
sessing a  strong  ethereal  odor,  and  is  very  volatile  and  inflam- 
mable in  ordinary  temperature.  Its  boiling  point  is  about 
50°  F.  It  is  due  to  this  low  boiling  or  vaporizing  point  that 
it  is  so  exactly  adapted  to  the  special  requirements  of  a  local 
anaesthetic.  It  is  put  up  in  convenient  glass  tubes,  drawn  out 
to  a  fine  point,  and  hermetically  sealed. 

The  point  of  the  tube  is  marked  by  a  file  scratch  at  its 
smallest  part.  Here  the  point  is  broken  off  when  ready  for 
use,  either  by  the  fingers  or  the  forceps.  Immediately  the 
chloride  in  a  gaseous  state  escapes  from  the  small  opening,  and 
if  the  tube  is  partially  inverted,  a  small  jet  of  the  liquid  is 
projected  ;  this  is  further  accelerated  by  allowing  a  good  por- 
tion of  the  tube  to  come  in  contact  with  the  hand,  the  warmth 
of  which  hastens  the  vaporization  of  the  liquid. 

The  preparation  of  chloride  of  ethyl,  as  spoken  of 
above  (in  glass  tubes),  is  a  patented  process,  controlled  by 


ANAESTHETICS.  87 

P.  Monnet,  of  Lyons,  France.  As  the  chloride  evaporates 
in  ordinary  temperature  and  is  very  inflammable,  the  point 
has  to  be  drawn  out  and  sealed  while  the  tube  and  its  con- 
tents are  immersed  in  ice  water. 

The  Application  and  Action. — When  about  to  apply, 
the  parts  to  be  anaesthetized  should  be  thoroughly  dried,  by 
means  of  absorbent  cotton  or  napkin,  then  the  point  of  the 
tube  should  be  broken,  as  previously  directed,  and  the  fine 
jet  of  chloride  directed  upon  the  surface. 

If  teeth  are  to  be  extracted,  a  napkin  should  be  placed  in 
the  mouth  back  of  the  teeth  to  be  operated  upon,  and  the 
patient  directed  to  breathe  entirely  through  the  nose ;  the 
liquid  should  then  be  projected  upon  the  mucous  membrane 
around  the  tooth  or  root  and  upon  the  cheek  over  the  track  of 
the  inferior  maxillary  nerve  for  the  lower,  and  on  the  temple 
over  the  emergence  of  the  fifth  nerve  for  the  upper  teeth. 
This  application  upon  the  face,  however,  need  not  be  made 
unless  the  teeth  are  very  difficult  to  extract,  and  prolonged 
anaesthesia  is  desired. 

It  is  seldom  necessary  to  use  the  entire  contents  of  a  tube 
for  a  single  operation  ;  from  one-quarter  to  a  half  will  usually 
produce  complete  anaesthesia  of  the  parts.  The  opening  in 
the  tube  can  then  be  closed  and  the  contents  preserved  for 
a  subsequent  operation  by  folding  a  small  piece  of  rubber  dam 
and  placing  it  over  the  end  and  over  this  stretch  a  wide  rubber 
band,  from  end  to  end ;  then  place  the  tube  in  an  upright 
position,  preferably  in  a  glass  of  cold  water. 

The  writer  has  employed  chloride  of  ethyl  in  over  two 
hundred  minor  surgical  operations  with  uniform  success.  It 
is  a  most  satisfactory  local  anaesthetic  in  the  extraction  of 
teeth,  lancing  of  abscesses,  removal  of  small  tumors,  extrac- 
tion of  the  tooth  pulp,  and  in  the  preparation  of  roots  of  teeth 
and  the  fitting  of  bands  and  caps  in  crown-  and  bridge-work. 


SS  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

EUCAINE  HYDROCHLORATE,  ''A." 

Derivation. — EucaiVie  hydrochlorate  *'A"  is  obtained 
by  the  action  of  one  naolecule  of  ammonia  upon  three  mole- 
cules of  aceton  which  fornns  triacetonamin.  This  is  then 
transformed  into  dry  triacetonamincyanhydrin  by  hydrocyanic 
acid. 

This  compound  when  saponified  becomes  triacetonalkamin- 
carbonic  acid,  ammonia  being  given  off  in  the  process. 

When  benzylated  and  methylated  we  get  n-methyl-ben- 
zoyltetramethyly-oxypiperidincarbonic  acid-methylester,  or 
eucaine. 

As  will  be  apparent  from  this  synthesis,  eucaine  is  nof  a 
coal-tar  product. 

Properties  and  Actions. — Eucaine  (A)  is  a  white,  neu- 
tral, crystalline  powder,  soluble  in  ten  parts  cold  water,  mak- 
ing about  a  nine  per  cent,  solution.  This  solution  is  stable 
and  may  be  boiled  without  suffering  deterioration.  It  may 
be  employed  in  all  cases  where  cocaine  is  used  and  in  similar 
strength  or  stronger,  since  the  two  drugs  are  quite  similar  as 
regards  the  rapidity,  intensity,  and  duration  of  anaesthesia; 
eucaine,  however,  being  much  less  toxic. 

Therapeutics.  —Eucaine  is  employed  as  a  local  anaesthetic 
for  minor  surgical  operations,  and,  as  has  been  indicated,  the 
only  important  difference  of  this  drug  and  cocaine,  physiologi- 
cally or  therapeutically,  is  the  difference  in  their  toxic  effects. 
It  is  claimed,  after  many  careful  experiments,  that  the  pulse  is 
not  materially  affected  by  the  use  of  eucaine,  either  in  rate  or 
character.  Some  writers  have  stated  that  unpleasant  disturb- 
ances of  sensation  follow  the  use  of  this  drug,  particularly 
when  used  upon  the  pharynx.  These  disturbances,  however, 
are  less  unpleasant  and  less  marked  than  those  produced  by 
cocaine,  and    are    more   transient,  and,   speaking  generally. 


STIMULANTS.  89 

after  the  lapse  of  an  hour  from  the  time  of  application,  the 
subjective  sensations  may  be  described  as  normal. 

Dental  Uses. — In  dental  practice,  eucaine,  from  two  to 
five  per  cent,  solution,  is  employed  as  a  local  anaesthetic  in 
the  extraction  of  teeth  ;  it  is  applied  locally,  by  freely  bathing 
the  parts,  for  lancing  painful  abscesses;  is  injected  hypoder- 
matically  in  minor  surgical  operations  in  the  mouth,  such  as 
the  removal  of  small  tumors,  necrosed  bone,  and  in  operations 
upon  the  antrum  of  Highmore.  Eucaine  may  also  be  em- 
ployed, cataphorically,  for  the  obtunding  of  sensitive  dentine, 
the  removal  of  the  dental  pulp,  etc.  The  writer  has  secured 
very  satisfactory  results  with  a  ten  per  cent,  solution  of  the 
drug,  both  as  a  local  anaesthetic  in  operations  upon  the  antrum, 
and  in  conjunction  with  cataphoric  instruments  in  the  usual 
dental  operations. 


STIMULANTS. 

Stimulants  are  medicinal  agents  which  increase  organic 
activity.  The  most  powerful  and  rapid  in  action,  though 
transient  in  effect,  are  termed  diffusible  stimulants,  while  the 
local  stimulants,  which  are  of  a  vegetable  nature,  containing 
a  volatile  oil,  are  termed  aromatic. 

Among  the  first  class  are  such  agents  as  the  alcoholic 
preparations,  ammonia,  camphor,  ether,  nitrite  of  amyl, 
myrrh,  etc. 

The  principal  members  of  the  class  of  aromatic 
stimulants  are  capsicum,  oil  of  cloves,  peppermint,  etc. 
Heat  and  cold  also  act  as  local  stimulants. 

ALCOHOL,  C2H6O. 
Derivation. — Alcohol  is  obtained  by  repeated  distillations 
from  the  product  of  fermented  grain  or  starchy  substances, 


90  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

easily  converted  into  grape  sugar,  which  in  the  presence  of 
and  by  the  growth  of  low  vegetable  organisms  (the  yeast 
plant,  etc.)  splits  up  into  alcohol  and  CO2.  Commercial 
alcohol  contains  about  90  per  cent,  of  absolute  alcohol  with 
10  per  cent,  of  water. 

Properties  and  Action. — Alcohol  is  a  colorless,  inflam- 
mable fluid,  wholly  vaporizable  by  heat,  and  unites  in  any 
proportion  with  water  and  ether.  It  possesses  a  pungent 
odor  and  burning  taste.  All  of  the  alcoholic  preparations 
are  powerful  diff"usible  stimulants,  causing  general  exhilaration 
of  spirits. 

In  large  doses,  however,  it  is  a  depressant,  producing 
muscular  incoordination  and  the  effects  of  narcotic  poisons, 
ending  in  delirium,  coma,  and  death. 

The  Most  Important  Alcohols  are — 

Methylic  Alcohol,  CjH^O,  methyl  hydrate,  wood  spirit. 

Ethylic  Alcohol,  CaHgO,  ethyl  hydrate,  grain  spirit. 

Amylic  Alcohol,  C5H12O,  amyl  hydrate,  potato  spirit, 
also  occurs  with  the  ethylic  alcohol,  in  excessive  distillations 
of  fermented  grain. 

Principal  Preparations  of  Alcohol ; — 

Absolute  Alcohol,  rarely  obtainable  in  the  shops,  how- 
ever, stronger  than  98  per  cent. 

Alcohol  contains  about  91  per  cent,  of  absolute  alcohol. 

Alcoholis  Dilutum  contains  equal  parts  of  alcohol  and 
water. 

Spiritus  Frumenti,  whisky  from  rye,  corn,  barley,  and 
potatoes,  contains  from  45  to  50  per  cent,  of  alcohol. 

Rum,  obtained  by  the  distillation  of  fermented  molasses. 

Wines — port  wine,  sherry  white  wine  (made  by  ferment- 
ing the  juice  of  the  grape  without  the  seeds,  stems,  or  skins); 
red  wine  (from  the  juice  of  grapes  with  their  skins) ;  cham- 


STIMULANTS.  9 1 

pagne,  claret,  Rhine,  etc.     These  contain  from   5  to  40  per 
cent,  of  alcohol. 

Beer  by  slow  fermentation,  contains  2  to  3  per  cent,  alcohol. 

Ale,  by  rapid  "  "        2  to  6      " 

Porter  and  stout  "        4  to  6      "  " 

Therapeutic  Uses. — The  alcoholic  preparations  are 
most  valuable  agents  in  disease,  for  appropriate  cases;  they 
are  employed  as  stimulants  in  acute  inflammations,  such  as 
pneumonia,  pleurisy,  bronchitis,  phthisis,  and  in  the  last 
stages  of  typhoid  fever,  diphtheria,  acute  neuralgia,  etc.  In 
insomnia  from  cerebral  anaemia,  small  doses  of  some  alco- 
holic stimulant  at  bedtime  are  found  beneficial.  In  poisoning 
by  cardiac  depressants  and  snake  venom,  alcohol,  freely, 
sustains  the  heart.  In  chloroform  anaesthesia,  an  ounce  of 
whisky  beforehand  will  sustain  the  heart  and  prolong  narcosis. 

Dental  Uses. — In  the  administration  of  nitrous  oxide 
gas,  a  small  quantity  of  wine  taken  beforehand  will  often  be 
found  beneficial,  increasing  the  heart's  action  at  about  the 
time  the  efl'ects  of  the  anaesthetic  are  passing  off.  In  painful 
operations  upon  the  teeth,  I  have  found  small  doses  of  sherry 
or  champagne  to  be  very  beneficial. 

As  a  styptic,  it  arrests  hemorrhage  by  coagulating  the 
blood  by  its  effects  upon  albumin,  and  contracts  the  mouth  of 
the  vessels  by  its  astringent  properties. 

For  suppurating  wounds  it  is  a  useful  antiseptic  dress- 
ing. 

For  the  treatment  of  softened  and  sensitive  den- 
tine, and  for  drying  cavities  preparatory  to  filling,  absolute 
alcohol  is  generally  an  efficient  agent ;  after  drying  the  cavity 
with  cotton  or  bibulous  paper,  it  should  be  bathed  with  alco- 
hol, which  evaporates  rapidly  and  causes  the  almost  perfect 
absorption  of  moisture  from  the  dentine. 


92  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Treatment  of  Acute  Alcoholism. — Evacuate  the  stom- 
ach, administer  ammonia  cautiously  by  inhalation,  apply 
warmth  to  the  extremities  and  cold  affusion  to  the  head,  and, 
if  need  be,  artificial  respiration. 

AMMONIA. 

Medicinal  Properties  and  Action. — It  exists  most 
commonly  in  the  form  of  ammonia  gas,  NH3 ;  which,  dis- 
solved in  water,  is  the  aqua  ammoniae  of  commerce.  It  is 
intensely  alkaline,  and  is  an  irritant  to  the  mucous  mem- 
brane. When  inhaled,  it  acts  as  a  stimulant,  especially 
as  an  antagonist  of  cardiac  depressants.  Prolonged  inhala- 
tion induces  spasmodic  coughing,  a  sense  of  suffocation, 
and  inflammation  and  oedema  of  the  glottis  ;  when  swallowed, 
the  aqua  sets  up  violent  inflammation  of  the  passages  and 
stomach. 

The  salts  of  ammonia,  in  medicinal  doses,  are  stimulat- 
ing expectorants,  and  stimulate  the  heart's  action  ;  while  in 
large  doses  or  continued  use  they  produce  rapid  emaciation, 
by  impairing  digestion  and  increasing  tissue  waste.  In  large 
doses  they  also  injure  the  red  blood  corpuscles. 

Principal  Preparations : — 

Aqua  ammoniae,  water  of  ammonia,  containing  10  per 
cent,  of  the  gas  in  water.     Dose,  n\^v-xxx,  diluted. 

Aqua  ammoniae  fortior,  containing  28  per  cent,  of  the 
gas  in  solution. 

Ammonium  carbonate.     Dose,  gr.  ij-x. 

Ammonium  chloride,  sal  ammoniac.     Dose,  gr.  j-xx. 

Ammonia  spirits  (a  10  per  cent,  solution  of  aqua 
ammoniae  in  alcohol).     Dose,  nix-^j,  diluted. 

Aromatic  spirits  of  ammonia,  the  carbonate  with  aro- 
matics  (oil  of  lemon,  lavender,  etc.,  and  alcohol  and  water). 
Dose,  in^x-^ij. 


STIMULANTS.  93 

Ammonia  liniment,  aqua  ammoniae,  30  per  cent.,  and 
cotton-seed  oil,  70  per  cent. 

Ammonium  nitrate,  used  in  preparing  nitrous  oxide  gas, 
Ammonium  sulphate,  used  in  preparing  other  ammo- 
nium salts,  etc. 

CAMPHOR,  CjoHigO. 

Source. — Camphor  is  a  white,  concrete,  and  translucent 
gum,  obtained  from  the  volatile  oil  of  the  camphor  laurel,  an 
evergreen  tree  indigenous  in  China,  Japan,  Formosa,  etc. 
Refined  camphor  is  prepared  in  large  circular  cakes,  one  to 
two  inches  thick. 

Properties  and  Action. — Camphor  is  slightly  soluble  in 
water  (about  i  to  1300),  but  freely  in  alcohol,  ether,  chloro- 
form, oils,  and  milk.  Alcohol  forms  a  75  per  cent,  solution. 
It  has  a  penetrating,  fragrant  odor,  a  bitter,  pungent  taste, 
leaving  a  slight  sense  of  coolness.  It  is  a  stimulant,  anodyne, 
diaphoretic,  antiseptic,  and  irritant. 

In  medicinal  doses  it  temporarily  increases  the  heart's 
action,  stimulates  respiration  and  mental  activity,  promotes 
perspiration,  and  allays  pain  and  spasm. 

Large    doses    depress    the    heart    and    excite    narcotic 
symptoms,  and  have  proved  fatal. 

Principal  Preparations  : — 

Aqua  camphorse,  camphor  water  (8  parts  of  camphor  to 
1000  of  distilled  water,  with  16  parts  of  alcohol  to  aid  in  the 
suspension  of  camphor).      Dose,  3J-iv. 

Spiritus  camphorse,  spirit  of  camphor  (camphor,  ^iv, 
alcohol,  Oj).     Dose,  rr\^v-xx. 

Linimentum  camphorse,  camphor  liniment  (camphor  i 
part  to  olive  oil  4  parts). 

Linimentum  saponis,  soap  liniment  (soap  10  parts, 
camphor  5,  oil  rosemary,  i,  alcohol  70,  water  15).  Is  an 
anodyne  and  mild  irritant  for  sprains,  rheumatic  pains,  etc. 


94  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Dental  Use. — In  dental  practice  the  spirit  of  camphor  is 
sometimes  employed  by  local  application  to  allay  the  pain  of 
s<ensitive  dentine,  and  that  which  sometimes  follows  the  ex- 
traction of  teeth,  and  the  wounding  of  pulps  of  teeth.  Cam- 
phor is  also  employed  in  the  treatment  of  putrescent  root 
canals  of  teeth.  It  is  also  one  of  the  ingredients  of  the 
celluloid  base  for  artificial  teeth. 

NITRITE  OF  AMYL,  C-Hj^NO^. 

Derivation. — Nitrite  of  amyl  is  produced  by  the  action  of 
nitric  or  nitrous  acid  upon  amylic  alcohol. 

Properties  and  Action. — Nitrite  of  amyl  is  a  clear, 
yellowish,  oily  liquid.  It  has  an  ethereal  odor,  and  is  very 
volatile  and  inflammable;  it  is  insoluble  in  water,  but  soluble 
in  alcohol,  ether,  and  chloroform.  It  is  used  by  inhalation, 
causing  great  cardiac  activity,  vascular  dilatation,  flushing  of 
the  face,  a  sense  of  fullness  of  the  brain,  and  complete  reso- 
lution of  the  muscular  system.  It  is  a  muscle  poison,  and 
when  the  vapor  is  applied  directly  to  the  muscular  or  nervous 
tissues  it  arrests  their  functional  activity. 

Dental  Use. — Nitrite  of  amyl,  being  a  powerful  stimulant 
to  the  heart,  is  employed  in  syncope  and  chloroform  narcosis. 
It  is  also  used  in  epileptic  attacks  and  other  convulsive  or 
spasmodic  diseases.  Cases  are  reported  where  nitrite  of  amyl 
has  restored  the  patient  after  artificial  respiration  had  failed. 
Care,  however,  must  be  observed  in  its  use,  as  it  is  a  powerful 
and  dangerous  agent. 

Dose  of  7iitnte  of  amyl  by  inhalation  is  from  rc\^\]  to  n^v. 
Not  more  than  two  or  three  drops  should  be  administered  to 
weak  and  nervous  patients  who  are  susceptible  to  its  influence. 


STIMULANTS.  95 

MYRRH. 

Source. — Myrrh  is  a  resinous  exudation  from  a  small  tree 
grown  in  Arabia  and  the  northeastern  coast  of  Africa,  known 
as  the  Balsat?iodendron  itiyrrha.  It  is  a  spontaneous  exuda- 
tion from  the  stems  of  the  tree,  which  collects  in  small  masses 
upon  the  bark. 

Properties  and  Action. — Myrrh  is  brittle  and  is  easily 
pulverized.  It  is  of  a  reddish-yellow  color,  translucent,  with 
an  aromatic  taste  and  a  peculiar  fragrant  odor.  When  pul- 
verized the  powder  is  of  a  light  yellow  color,  if  pure.  In 
medicinal  doses,  myrrh  is  a  stimulant  and  astringent.  It 
stimulates  the  digestive  organs  and  improves  the  appetite,  but 
in  larger  doses  it  acts  as  an  irritant  to  the  gastro-intestinal 
membrane.  It  is  employed  externally  as  a  local  application 
to  inflamed,  ulcerated,  and  relaxed  tissues,  for  its  stimulating 
and  astringent  effect. 

Dose. — Powdered  myrrh,  gr.  x  to  ^ss,  in  pill  form  or 
suspended  in  water.  Tincture  of  myrrh,  ^ss  to  j  (myrrh 
^iij,  alcohol  Oij). 

Dental  Use. — The  tincture  of  myrrh,  diluted,  forms  an 
excellent  gargle  and  mouth-wash,  and  a  stimulating  lotion  for 
spongy  and  inflamed  gums.  The  powder  is  employed  as  an 
ingredient  of  many  dentifrices  for  its  astringent  properties. 

CAPSICUM. 

Source. — Capsicum,  or  Cayenne  Pepper,  is  the  fruit  of 
Capsicum  fastigiatum,  a  plant  of  tropical  Africa  and  America. 
Its  pungent  odor  and  hot  taste  are  due  to  its  very  acrid  and 
volatile  principle,  called  capsicine. 

Medicinal  Properties  and  Actions. — Capsicum  in 
medicinal  doses  is  a  powerful  stimulant.  It  produces  a  sensa- 
tion of  warmth  in  the  stomach,  and  a  general  glow  over  the 


96  DENTAL   PATHOLOGY    AND    DENTAL   MEDICINE. 

body  ;  it  stimulates  the  circulation  and  digestive  process,  but 
in  excessive  doses  it  acts  as  an  irritant  poison. 

Preparations  : — 

Tincture  Capsicum.     Dose,  tt^v-^j. 

Powdered  Capsicum.     Dose,  gr.  v-x  in  pills. 

Emplastrum  Capsicum.     A  most  excellent  plaster. 

Dental  Use. — Capsicum  in  tincture  or  plaster  form,  pre- 
ferably the  latter,  is  very  serviceable  in  dental  periostitis, 
as  it  aids  in  establishing  resolution  or  hastens  suppuration.  It 
is  also  an  excellent  stimulating  gargle,  tinct.  capsicum,  ^ss 
to  rose  water,  ^viij. 

OIL  or  CLOVES. 

Source. — The  oil  of  cloves  is  obtained  from  the  dried, 
unexpanded  flowers  of  the  Eugenia  caryophyllata,  an  ever- 
green tree  of  the  myrtle  order,  a  native  of  the  Indies. 

Properties  and  Actions. — The  oil  of  cloves,  when  fresh, 
is  a  clear  and  colorless  preparation  ;  it  has  a  pungent,  spicy 
taste,  and  a  fragrant  odor.  Is  an  aromatic  stimulant,  irritant 
and  antiseptic.  It  is  sometimes  administered  to  relieve 
nausea,  and  prevent  griping  when  combined  with  purgatives, 
also  to  modify  the  action  of  other  medicines.     Dose,  M^j-v. 

Dental  Use. — The  oil  of  cloves  is  employed  in  dental 
practice  to  relieve  odontalgia,  by  introducing  two  or  three 
drops  into  the  carious  cavity  of  the  aching  tooth,  relieving 
the  pain  by  its  stimulating  effect  upon  the  pulp.  It  is  some- 
times used  for  the  same  purpose  in  combination  with  other 
agents,  and  has  the  effect  of  rendering  carbolic  acid  more 
pleasant,  without  interfering  with  its  action.  It  is  used  also 
by  microscopists  to  clarify  preparations  for  mounting. 

Eugenol  (CioHj^Oa)  is  an  active  principle  of  oil  of  cloves. 
It  is  sometimes  called  an  acid,  as  it  possesses  some  acid 
qualities.     It  is  a  clear,  colorless  oil,  and  its  odor  and  taste 


TONICS.  97 

resemble  those  of  the  oil  of  cloves.     It  is  an  excellent  anti- 
septic for  dental  uses. 

PEPPERMINT. 

Source. — Mentha  piperita,  or  peppermint,  is  grown  every- 
where, and  as  a  plant  is  familiar  to  every  one.  The  leaves 
and  tops  are  used  for  medicinal  purposes. 

Properties  and  Actions. — The  properties  of  peppermint 
are  due  to  a  volatile  oil,  in  which  form  it  is  generally  used. 
It  is  an  aromatic  stimulant,  carminative  and  antispasmodic, 
and  local  anodyne  and  anaesthetic  when  evaporation  is  pre- 
vented after  being  applied  to  the  surface. 

Preparations : — 

Oil  of  Peppermint  (consisting  largely  of  menthol). 
Dose,  yrij-v. 

Peppermint  Water  (2  parts  of  the  oil  to  1000  of  dis- 
tilled water).     Dose  indefinite. 

Essence  of  Peppermint  (10  per  cent,  of  oil  with  i  per 
cent,  of  the  powdered  herb  in  alcohol).     Dose,  }\  x-xxx. 

Dental  Use. — Local  anodyne  and  anaesthetic. 


TONICS. 

Tonics  are  agents  which  give  healthful  activity  and  vigor  to 
the  functions,  gradually  imparting  strength  and  tone  to  the 
system,  that  is,  without  preternatural  excitement.  They  are 
divided  into  vegetable  and  mineral  tonics. 

Principal  among  the  vegetable  tonics  are  cinchona, 
nux  vomica,  digitalis,  cimicifuga,  and  eucalyptus. 

While  the  principal  mineral  tonics  are  the  prepara- 
tions of  iron,  arsenic,  zinc,  sulphuric  acid,  nitric  acid,  muri- 
atic acid,  etc. 


98  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

CINCHONA  (PERUVIAN  BARK). 

Source. — Cinchona  is  the  bark  of  any  variety  of  cinchona. 
The  different  species  of  this  tree  are  natives  of  the  mountains 
of  western  South  America,  especially  in  Peru  and  Bolivia, 
though  they  have  been  planted  and  are  grown  in  India,  Cey- 
lon, and  Burmah. 

The  medicinal  properties  of  these  barks  depend  upon 
the  alkaloids  they  contain,  which  are  in  varying  proportions, 
usually  from  3  to  4  per  cent.,  at  least  2  per  cent,  of  which  is 
quinine,  this  being  the  most  important. 

Principal  preparations  of  cinchona  and  its  alkaloids 
are  as  follows  : 

Powdered  Cinchona.     Dose,  gr.  x-^iij. 

Tincture  Cinchona  (strength  20  per  cent.).  Dose, 
5J-Sss. 

Extract  Cinchona  (in  pill).     Dose,  gr.  j-x. 

Sulphate  of  Quinine.     Dose,  gr.  j-xx. 

Sulphate  of  Cinchonidine  (one-half  the  strength  of 
quinine).  Dose,  gr.  ij-xxx.  Much  used  in  hospital  and 
dispensary  work. 

Properties  and  Actions. — The  different  varieties  of 
cinchona  are  named  according  to  their  color.  Yellow  cin- 
chona— cinchona  flava  ;  pale  cinchona — cinchona  pallida; 
red  cinchona — cinchona  rubra.  The  powder  from  the  yellow 
bark  is  of  an  orange  color  ;  has  a  more  bitter  taste  than  the 
other  barks,  containing  more  of  the  alkaloid  quinine.  Cin- 
chona is  a  bitter  tonic,  astringent,  antipyretic,  and  antiseptic. 
The  alkaloid  quinine  is  preferable  for  ordinary  use,  as  a  much 
larger  quantity  of  the  powdered  bark  is  necessary  to  obtain 
the  full  effects,  often  causing  derangement  of  the  stomach, 
headache,  and  constipation. 

Dental  Uses. — In  dental  practice  quinine  is  employed  in 


TONICS.  99 

from  five  to  ten  grain  doses  as  a  tonic,  and  in  the  treatment 
of  neuralgia  when  due  to  malaria.  Cinchona  is  also  used  as 
an  antiseptic.  ''The  powder  dusted  over  unhealthy  wounds 
will  arrest  putrefaction  and  promote  healthy  cicatrization. 
Quinine  will  destroy  minute  organisms,  and  preserve  sub- 
stances from  decomposition."  *  Cinchona  is  also  employed 
for  its  antiseptic  and  tonic  properties  as  an  ingredient  in 
certain  dentifrices. 

NUX  VOMICA. 

Source. — Nux  vomica  is  the  seeds  of  the  Strychnos  nucis 
vomica,  a  tree  of  the  family  Strychnoides,  which  grows  in 
India.  These  seeds  have  been  long  sold  in  the  shops  under 
the  names  of  nux  vomica,  bachelor's  buttons,  poison  nuts, 
etc.,  and  for  a  long  time  were  used  only  for  such  purposes 
as  poisoning  rats. 

Medicinal  Properties  and  Actions. — Nux  vomica  con- 
tains two  alkaloids,  strychnine  and  brucine,  to  which  its 
medicinal  properties  are  chiefly  due.  Brucine  has  only  -^-^ 
the  strength  of  strychnine,  but  they  are  otherwise  identical, 
physiologically  and  therapeutically. 

In  small  doses  nux  vomica  is  a  bitter  tonic,  exciting  the 
secretions  and  stimulating  the  functions  of  the  body. 

In  full  doses  (strychnine  gr.  Jg-)  the  function  of  the 
spinal  cord  is  exalted,  causing  tetanic  spasms  of  the  extensor 
muscle,  the  lower  jaw  is  stiff,  the  pupils  dilated,  and  the  face 
wears  an  unmeaning  smile. 

In  toxic  doses  (strychnine  gr.  ^2)  the  function  of  the 
spinal  cord  is  paralyzed,  respiration  is  arrested,  death  follow- 
ing from  asphyxia;  consciousness  is  preserved,  however,  until 
CO2  narcosis  takes  place. 

*  Gorgas'  "Dental  Medicine."' 


too  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Treatment  of  Strychnine  Poisoning. — The  antidote 
is  tannic  acid,  which  forms  an  insohible  tannate;  then  the 
stomach  pump  should  be  employed  or  emetics  administered, 
after  which  the  patient  should  be  kept  perfectly  quiet. 

The  antagonists  are  chloral,  chloroform,  and  potassium 
bromide ;  the  last  named,  though,  is  rarely  used,  on  account 
of  its  being  so  slow  of  action. 

The  bladder  must  be  evacuated  frequently,  lest  a  re- 
absorption  of  the  poison  take  place. 

Preparations : — 

Abstract  of  Nux  Vomica. — Dose,  gr.  ^  gradually  in- 
creased to  gr.  j. 

Tincture  of  Nux  Vomica  (20  per  cent,  of  the  drug). 
Dose,  T^j-x. 

Extract  of  Nux  Vomica.     Dose,  gr.  }i-]. 

Fluid  Extract  of  Nux  Vomica.     Dose,  n\^j-v. 

Sulphate  of  Strychnine.     Dose,  gr.  y^q-j^- 

Dental  Uses. — Where  a  cardiac  or  nerve  tonic  is  required, 
nux  vomica  and  its  chief  alkaloid  hold  the  first  rank. 

DIGITALIS. 

Source. — Digitalis,  or  foxglove,  is  the  leaves  of  £>igi7a It's 
purpurea,  or  purple  foxglove  :  the  leaves  of  the  second  year's 
growth  are  considered  the  best.  The  plant  grows  wild  in 
Europe,  and  is  cultivated  in  this  country,  where  it  is  some- 
times seen  in  private  gardens,  grown  for  its  beautiful  spike  of 
purple  flowers.  The  Shakers  cultivate  it  quite  extensively  for 
the  drug  market. 

Medicinal  Properties  and  Actions. — Digitalis  is  chiefly 
used  in  disease  for  its  tonic  and  diuretic  properties,  its  tonic 
eff'ect  upon  the-  heart,  principally  ;  though  the  heart  is  slowed 
by  its  action,  its  force  is  at  the  same  time  increased.  For  the 
full  cardiac  effects  the  recumbent  posture  should  be  maintained. 


TONICS.  lOI 

When  the  doses  are  large,  severe  gastric  disturbance  is  caused. 
In  toxic  doses,  the  muscles  and  peripheral  nerves  are  paralyzed  ; 
respiration  is  first  slowed  and  then  becomes  rapid  and  feeble; 
coma  and  convulsions  followed  by  death  from  the  sudden 
paralysis  of  the  heart. 

Preparations  and  Doses  : — 

Digitalis  (the  leaves).     Dose,  gr.  ss-iij. 

Abstract  of  Digitalis.  Dose,  gr.  ^-j  (strength  200 
per  cent.). 

Extract  of  Digitalis.     Dose,  gr.  i^-j. 

Fluid  Extract  of  Digitalis.     Dose,  TT|^j-iij. 

Tincture  of  Digitalis  (15  per  cent.).     Dose,  n\^v-xx. 

CIMICIFUGA. 

Source. — Cimicifuga,  or  the  black  snakeroot,  is  the  root 
of  the  Cimicifuga  racemosa,  a  common  plant  in  the  United 
States. 

Medicinal  Properties  and  Actions. — Cimicifuga  has  a 
bitter  and  nauseous  taste,  somewhat  resembling  that  of  opium. 
It  is  an  efficient  cardiac  tonic,  antispasmodic,  diaphoretic,  and 
diuretic.  It  is  feebler  in  its  action  than  digitalis,  and  should 
be  used  more  frequently  when  the  latter  drug  is  indicated. 

Preparations  and  Doses  :  — 
Fluid  Extract  of  Cimicifuga.     Dose,  n^^v-xxx. 
Tincture    of   Cimicifuga    (20    per   cent,  in    strength). 
Dose,  n^xx-lx  (5J). 

EUCALYPTUS. 

Source. — Eucalyptus  is  obtained  from  the  leaves  of  the 
Eucalyptus  globulus,  or  ''blue  gum  tree,"  a  native  of  Austra- 
lia, but  is  now  grown  in  Northern  Africa,  Southern  Europe, 
and  in  the  United  States. 

Properties  and  Actions. — The  leaves  are  the  only  por- 


I02  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

tion  of  the  tree  which  possesses  medicinal  qualities,  the  fresh 
being  more  active  than  the  dried  leaves.  Tlieir  medicinal 
properties  are  due  to  a  volatile  oil,  called  oleum  eucalypti, 
which  contains  three  oils,  eucalyptene,  turpene,  and  cymol, 
which  distill  over  at  different  temperatures,  the  first  product 
being  the  most  important.  Eucalyptus  promotes  appetite  and 
digestion,  and  increases  the  heart's  action. 

In  large  doses  it  causes  indigestion,  nausea,  diarrhoea,  and 
great  muscular  weakness,  and  if  continued  will  cause  irritation 
and  congestion  of  the  kidneys.  It  is  eliminated  by  the  skin, 
bronchial  mucous  membrane,  and  kidneys,  the  secretions  of 
which  become  strongly  odorous,  owing  to  the  presence  of  the 
oil.  Eucalyptus  is  also  an  antiseptic,  disinfectant,  sedative, 
and  diaphoretic,  ''and  has  anti-malarial  properties,  absorbing 
noxious  germs,  as  well  as  enormous  quantities  of  water  from 
the  soil,  and  by  its  emanations  purifying  the  atmosphere  in 
the  vicinity.  It  is  largely  cultivated  in  malarial  districts  for 
these  properties,  and  has  rendered  habitable  a  portion  of  the 
deadly  Roman  Campagna."  * 

Preparations  of  Eucalyptus  : — 

Extract.     Dose,  gr.  j-xv. 

Fluid  Extract.     Dose,  n\^xx-3j. 

Tincture.     Dose,  f^ss-ij. 

Oil.     Dose,  iTLv-xx  in  emulsion  or  capsules. 

Dental  Use. — In  dental  practice  the  oil  of  eucalyptus  is 
employed  either  alone  or  combined  with  iodoform,  for  its 
antiseptic  properties,  in  the  treatment  of  putrescent  pulps  of 
teeth  and  chronic  alveolar  abscesses.  This  combination  has 
also  proven  very  efficient  in  the  treatment  of  necrosis  and 
caries  of  the  bone  of  the  jaws. 

By  taking   advantage  of  the   solvent   effect  of  eucalyptol 

*  Potter's  "  Materia  Medica." 


TONICS.  103 

upon  the  gutta-percha,  it  will  be  found  of  great  benefit  in  the 
insertion  of  fillings  of  this  material. 

IRON. 

Ferrum,  or  iron^  is  a  metal  of  a  bluish-gray  color,  fibrous  in 
texture,  is  hard,  ductile,  malleable,  and  magnetic.  Chemical 
analysis  demonstrates  the  presence  of  iron  in  the  bfood,  i  part 
to  230  of  red  corpuscles,  also  in  the  gastric  juice,  chyle,  bile, 
lymph,  urine,  milk,  and  pigment  of  the  eye. 

Properties  and  Actions. — Iron  taken  into  the  stomach 
in  the  metallic  state,  meeting  with  the  acids  of  that  cavity,  is 
dissolved,  which  causes  an  evolution  of  hydrogen  gas,  and 
gives  to  the  iron  molecular  activity.  Given  i?iedicinally  in 
small  doses,  the  salts  of  iron  act  through  and  upon  the  blood, 
improving  its  quality  and  increasing  the  number  of  red 
corpuscles ;  they  also  promote  the  appetite  and  improve 
digestion,  and  hence  it  is  recognized  as  one  of  the  most 
efficient  tonics. 

In  large  doses  these  salts  cause  nausea  and  vomiting  and 
act  as  irritants.  Or  the  prolonged  administration  of  small 
doses  exhausts  the  gastric  glands  by  over-stimulation. 

Monsel's  preparations  of  iron  are  principally  used  ex- 
ternally, for  hemorrhage,  and  are  considered  to  be  among  the 
very  best  styptics  in  use.  When  internally  employed  it  is  for 
their  hemostatic  effect  in  hemorrhage  from  remote  organs. 
In  administering  iron  care  should  be  exercised,  as  nearly  all 
the  preparations  are  more  or  less  astringent,  and  act  injuriously 
on  the  teeth. 

Contra-indications. — Iron  should  never  be  given  when 
plethora  (a  superabundance  of  blood)  exists,  especially  when 
accompanied  with  a  hemorrhagic  tendency. 

Principal  Preparations  : — 

Tincture  of  the  Chloride  of  Iron.     Dose,  n^^v-xx. 


I04  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Powdered  Sulphate  of  Iron,  Monsel's  Powder.  Dose, 
gr.  ss-iij,  in  pill;  used  also  as  a  styptic. 

Solution  of  Subsulphate  of  Iron,  or  Persulphate, 
Monsel's  Solution.  Possesses  powerful  astringent  proper- 
ties ;  used  only  as  a  styptic. 

Dental  Uses. — In  dental  practice  the  chief  indications 
for  iron  are  where  hemorrhage  follows  the  extraction  of  teeth, 
or  from  any  other  cause,  such  as  wounds  of  the  gums  and 
mucous  membrane.  Monsel's  solution  or  powder  is  em- 
ployed for  this  purpose.     See  chapter  on  Extraction  of  Teeth. 

ARSENIC,  As. 

Properties. — Arsenic  is  a  brittle,  granular  metal,  of  steel- 
gray  color,  is  very  combustible,  and  volatilizes  before  melting, 
the  vapor  having  an  odor  like  that  of  garlic.  It  is  a  powerful 
poison,  not  of  itself,  however,  but  by  virtue  of  the  facility 
with  which  it  absorbs  oxygen.  It  is  generally  found  in  cobalt 
ore.     It  is  not  employed  as  medicine  in  its  native  state. 

Preparations  : — 

Arsenious  Acid  (?),  White  Arsenic,  "  Ratsbane."    Dose, 

Solution  of  Arsenious  Acid,  i  per  cent,  solution 
(strength,  y^^-)  with  hydrochloric  acid  and  distilled  water. 
Dose,  Tr^ij-x,  after  meals. 

Solution  of  Potassium  Arsenite,  Fowler's  solution 
(strength,  y^-q).     Dose,  n^ij-x,  after  meals. 

White  Oxide  of  Arsenic  (AsaO^),  Arsenious  Acid,  is  in 
the  form  of  irregular  solid  lumps,  having  a  chalky  appearance 
externally,  though  it  is  often  perfectly  transparent  internally. 
It  is  usually  furnished  in  the  shops,  however,  in  the  form  of  a 
fine  white  powder,  and  is  often  adulterated  with  chalk  or  lime. 
It  is  odorless  and  has  a  faint  sweetish  taste. 

Physiological    Actions. — In   s?nall  doses,  arsenic    is  a 


TONICS.  105 

general  tonic,  promoting  the  appetite,  digestion,  and  cardiac 
action,  stimulates  mental  activity,  and  causes  rotundity  of 
form  and  clear  skin.  In  large  doses  it  becomes  a  violent 
corrosive  poison,  creates  skin  eruptions  and  itching  of  the  eye- 
lids, nausea,  dysentery,  and  an  irritable  and  feeble  heart, 
death  following  from  narcotism.  Externally,  it  is  a  powerful 
escharotic. 

Toxicology. — The  antidote  to  arsenic  is  the  hydrated 
oxide  of  iron.  After  the  prompt  evacuation  of  the  stomach 
this  should  be  administered,  the  dose  being  eight  times  the 
quantity  of  the  poison  taken.  This  should  be  followed  by 
mucilaginous  or  oily  drinks,  to  protect  the  mucous  membrane, 
and  iodide  of  potassium  or  alkaline  mineral  w^aters,  to  pro- 
mote elimination. 

Tests  for  Arsenic. — There  are  a  number  of  tests  for 
arsenic,  the  following  being  considered  the  best :  If  in  a  solid 
state,  place  the  suspected  material  on  burning  charcoal,  when 
the  arsenic,  if  present,  will  become  deoxidized  and  emit  the 
garlic  odor  spoken  of  above.  When  in  an  aqueous  solution, 
it  may  be  detected  by  adding  sulphide  of  ammonium,  which 
produces  a  yellow  sulphide  of  arsenic,  or  the  addition  first  of 
ammonia,  then  a  small  quantity  of  nitrate  of  silver,  will  pro- 
duce a  light  yellow  arsenite  of  silver.  Again,  the  addition  of 
potassa  and  sulphate  of  copper  produces  a  light  green  arsenite 
of  copper. 

Marsh's  Test. — The  most  delicate  test  for  arsenic  con- 
sists in  subjecting  the  material  to  the  action  of  nascent  hydro- 
gen.* The  arsenic  is  deoxidized  and  forms  with  the  hydrogen 
arseniuretted  hydrogen  gas;  this  also  has  the  peculiar  odor  of 
garlic,   burning  with    a   bluish-white  flame,    which    deposits 

*  Nascent  hydrogen  is  evolved  by  the  action  of  diluted  sulphuric  acid  on 
zinc. 


Io6  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

metallic  arsenic  in  the  form  of  a  black  spot  on  the  surface  of 
a  cold  plate  if  held  directly  in  the  flame. 

Reinsch's  test  consists  of  boiling  the  material  suspected 
of  containing  arsenic  with  hydrochloric  acid  and  copper  foil, 
when,  if  arsenic  is  present,  it  will  manifest  itself  in  the  form 
of  a  coating  of  gray  metallic  arsenic  upon  the  foil. 

Dental  Uses. — Arsenic  is  employed  in  dental  practice  for 
its  devitalizing  power  in  destroying  the  vitality  of  the  pulps 
of  teeth.  It  is  generally  combined  with  other  agents,  in  the 
form  of  paste  or.  fibre,  for  this  purpose.  But  I  have  found 
the  white  arsenic  alone  to  act  very  happily  when  applied  to 
the  pulp  and  retained  by  a  small  pledget  of  cotton  which  had 
been  previutisly  saturated  with  cocaine.  The  cavity  should  be 
completely  secured,  that  none  of  the  arsenic  come  in  contact 
with  the  part  outside  of  the  tooth. 

The  quantity  to  be  used  for  this  purpose  is  about  the  ^ 
of  a  grain,  and  the  time  required  is  usually  about  24  hours, 
though  there  are  instances  where  48  hours  or  more  are  required 
to  thoroughly  destroy  the  vitality. 

ZINC,  Zn. 

Properties. — Zinc  is  one  of  the  metallic  elements — it  is 
very  hard,  has  a  bluish-white  color,  and  the  fresh  surface  has 
considerable  lustre,  but  is  soon  dulled,  from  the  facility  with 
which  it  oxidizes. 

Principal  Preparations:  — 

Zinci  Oxidum.     Dose,  gr.  j-x,  insoluble  in  water. 

Zinci  Acetas.  Dose,  gr.  ^~ij ;  as  a  lotion,  gr.  ij  to  3J 
of  water,  in  which  it  is  very  soluble. 

Zinci  Sulphas.  Dose  as  a  tonic  and  astringent,  gr.  yV"J' 
As  an  emetic,  gr.  vj  in  3iv  of  water,  in  tablespoonful  doses, 
repeated  every  few  minutes  until  emesis  takes  place. 

Zinci  Carbonas  Praecipitatus.  As  ointment,  or  dusted 
over  wounds  as  a  protection. 


TONICS.  107 

Zinci  lodidi.     Dose,  gr.  ss-v,  in  the  form  of  a  syrup. 

Zinci  Chloridum,  tonic  and  escharotic.  Dose,  gr.  ss-ij, 
well  diluted. 

Zinci  Chloridum  Liquor,  solution  of  chloride  of  zinc, 
^  to  I  per  cent,  in  strength. 

Physiological  Actions. — The  salts  of  zinc  are  more  or 
less  poisonous,  the  soluble  salts,  the  acetate,  sulphide,  and 
chloride  being  corrosive  poisons.  /;/  small  doses  they  are 
tonic  and  astringent,  while  in  larger  quantities  they  are  strong 
emetics. 

The  sulphate  is  a  specific  emetic,  acting  without  much 
depression. 

The  chloride  is  a  powerful  and  penetrating  escharotic.  It 
is  also  a  useful  deodorizer  and  disinfectant.  **When  applied 
to  malignant  and  indolent  ulcers,  it  promotes  healthy  granu- 
lations, and  when  topically  applied  it  not  only  destroys  the 
diseased  structure,  but  excites  a  new  and  healthy  action  of 
surrounding  parts." 

The  antidotes  for  zinc  poisoning  are,  the  white  of  an  tgg, 
carbonate  of  soda,  magnesia,  etc. 

Dental  Uses. — In  dental  practice  the  chloride  of  zinc 
(ZnCla)  is  a  valuable  agent.  It  is  employed  as  an  obtunding 
agent  for  sensitive  dentine — the  sensitive  surface  being  pre- 
viously bathed  with  chloroform,  which  will  modify  the  painful 
action  of  the  chloride.  It  has  also  been  employed  as  a  styptic 
to  arrest  superficial  hemorrhage  from  a  wound  of  the  gum 
during  the  filling  of  the  teeth.  It  induces  union  of  the  wounded 
parts  by  first  intention,  by  its  effect  upon  the  glutinous  matter, 
also  as  an  injection  for  chronic  alveolar  abscess,  and  in  dis- 
eases of  the  antrum  of  Highmore.  It  is  also  used  in  the 
recession  of  the  gum  and  the  absorption  of  the  alveolar  pro- 
cess from  the  necks  of  the  teeth.  The  application  can  be 
conveniently  made  by  means  of  a  piece  of  orange  wood,  so 


I08  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

shaped  as  to  permit  of  its  being  introduced  beneath  the  gums. 

The  chloride  of  zinc,  in  solution,  is  also  used  as  one  of 
the  ingredients  of  the  filling  material  known  as  the  oxychlo- 
ride  of  zinc,  the  other  ingredient  being  the  oxide  of  zinc. 

The  combination  of  these  two  forms  of  zinc  makes  an 
excellent  capping  material,  and  is  probably  the  best  of  all 
materials  for  root  filling.  , 

The  oxide  of  zinc — ZnO — is  sometimes  employed,  com- 
bined with  carbolic  acid,  in  the  form  of  a  paste,  for  capping 
exposed  pulps ;  it  is  also  one  of  the  ingredients  of  the  zinc 
filling  materials,  and  of  the  celluloid  base  of  artificial  teeth. 

The  sulphate  of  zinc — ZnSO^yHgO — is  sometimes  em- 
ployed in  disease  of  the  antrum  of  Highmore,  and  ulcerations 
of   the  mucous  membrane,  for  its  stimulant  and   astringent 

properties. 

SULPHURIC  ACID,  HjSO,. 

Properties. — Sulphuric  acid,  or  oil  of  vitriol,  is  a  dense, 
inodorous,  colorless,  oily,  and  corrosive  liquid.  It  consists  of 
not  less  than  96  per  cent,  sulphuric  anhydride  and  about  10 
per  cent,  of  water. 

Preparations  : — 

Sulphuric  Acid.     Used  as  an  escharotic  or  caustic. 

Diluted  Sulphuric  Acid  (10  per  cent,  of  the  acid  to  90 
per  cent,  of  water).      Dose,  ii\^v-xv,  well  diluted. 

Aromatic  Sulphuric  Acid  (Elixir  of  Vitriol).  Sulphuric 
acid  diluted  with  alcohol  and  flavored  with  ginger  and  cinna- 
mon (strength  20  per  cent.).     Dose,  tt|^v-xxv,  well  diluted. 

Action. — The  action  of  sulphuric  acid  in  its  different 
forms  is  as  follows  :  Aromatic  stilphuric  acid,  tonic  and  astrin- 
gent ;  diluted  sulphuric  acid,  tonic,  astringent,  and  refrigerant 
(in  fevers)  ;  sulphuric  acid,  escharotic. 

Treatment  of  Sulphuric  Acid  Poisoning. — Being  a 
corrosive  poison,  sulphuric  acid  causes  death  from  asphyxia 


TONICS.  109 

(the  suspension  of  vital  phenomena,  from  the  non-oxygena- 
tion  of  the  blood — an  excess  of  carbon  dioxide).  Administer 
alkalies,  as  washing  soda,  magnesia,  lime-water,  soapsuds,  etc., 
to  neutralize  the  acid,  and  mucilaginous  drinks  freely,  to  pro- 
tect the  mucous  membrane.  Stimulants,  opium,  ammonia 
intravenously,  to  combat  the  depressed  condition  of  the  vital 
powers. 

Dental  Uses. — The  concentrated  sulphuric  acid  is  em- 
ployed in  dental  practice  as  a  caustic ;  in  the  laboratory,  in  a 
diluted  state,  for  the  cleansing  of  metals  before  and  after 
soldering  (''  the  acid  bath").  It  is  also  used  in  the  manu- 
facture of  pyroxylin — gun  cotton. 

Aromatic  sulphuric  acid  is  more  agreeable  for  use  in 
the  mouth,  while  its  action  resembles  that  of  diluted  sulphuric 
acid.  It  is  a  valuable  agent  in  the  treatment  of  pyorrhoea 
alveolaris  and  necrosis  of  the  maxillary  bones,  stimulating  the 
parts  to  healthy  action.  It  is  also  employed  in  the  treatment 
of  chronic  alveofer  abscesses,  in  combination  with  a  few  drops 
of  tincture  of  capsicum. 

NITRIC  ACID,  HNO3. 

Properties. — Nitric  acid,  or  aqua  fortis,  is  a  highly  caustic 
liquid,  very  volatile,  its  fumes  being  corrosive  and  suffocating, 
and  in  the  pure  state  is  colorless  and  transparent,  but  that 
usually  found  in  shops  is  of  a  yellow  color,  owing  to  the  pres- 
ence of  nitric  peroxide.  Strong  nitric  acid  is  never  given 
internally;  it  is  used  in  the  form  of  the  diluted  fiitric  acidy  10 
per  cent,  absolute  acid.     Dose,  n\^iij-x,  well  diluted. 

Action. — Pure  nitric  acid  is  a  powerful  caustic  and  escha- 
rolic,  and  is  rarely  used  except  as  an  application  to  foul, 
indolent  ulcers,  or  to  warts.  The  diluted  acid  is  a  tonic, 
alterative,  and  refrigerant,  used  as  a  drink  in  fevers.  It  is,  as 
are  most  mineral  acids,   injurious  to  the  teeth ;  hence,  care 


no  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

should  be  taken  in  its  use.  It  should  be  taken  through  a  glass 
tube  or  quill,  and  followed  by  an  alkaline  mouth  wash.  It  is 
not  as  agreeable  to  the  stomach  as  diluted  sulphuric  acid. 

The  antidotes  for  nitric  acid  poisoning  are  magnesia 
or  soap  and  mucilaginous  drinks. 

Dental  Uses. — Nitric  acid  is  employed  in  dental  practice 
as  a  caustic  for  malignant  ulcers  of  the  mouth,  and  has  been 
used  for  devitalizing  pulps  of  teeth  when  nearly  exposed  by 
mechanical  abrasion.  It  is  also  used  in  combination  with 
hydrochloric  acid  (aqua  regia)  as  a  solvent  for  gold. 

PHOSPHORIC  ACID,  H3PO4. 

Properties. — Phosphoric  acid  is  a  solid,  colorless  com- 
pound, soluble  in  water  and  vitrifiable  by  heat  (converted  into 
glass).  It  is  obtained  from  bones,  where  it  exists  in  combina- 
tion with  lime.  Diluted  phosphoric  acid  is  the  form  in  which 
phosphoric  acid  is  usually  employed  in  medicine.  It  contains 
10  per  cent,  of  the  absolute  acid.     Dose,  tt|^v-xx. 

Action. — Phosphoric  acid  is  tonic  and  refrigerant,  and  in 
large  doses  an  irritant  poison.  It  has  been  employed  exter- 
nally in  the  treatment  of  osseous  tumors  and  caries  of  the 
bones. 

Glacial  phosphoric  acid,  HOPO5,  is  obtained  from 
calcined  bones.  They  are  first  treated  with  sulphuric  acid, 
'•'which  produces  an  insoluble  superphosphate  of  lime,  then 
dissolving  out  the  latter  salt  and  saturating  it  with  carbonate 
of  ammonia,  which  generates  phosphate  of  ammonia  in  solu- 
tion, and,  finally,  obtaining  the  phosphate  of  ammonia  by 
evaporating  to  dryness,  and  then  igniting  it  in  a  platinum 
crucible.  The  ammonia  and  all  of  the  water,  except  one 
equivalent  for  each  equivalent  of  the  acid,  are  driven  off,  and 
the  glacial  phosphoric  acid  remains.  It  is  a  white,  transpa- 
rent, fusible  solid,  generally  in  the  form  of  sticks,  inodorous, 


SEDATIVES.  Ill 

and  sour  to  the  taste.     It  slowly  deliquesces,  and  is  sparingly 
soluble  in  water,  but  freely  soluble  in  alcohol."  * 

Dental  Uses. — Phosphoric  acid  has  been  employed  in 
dental  practice  as  a  local  treatment  of  osseous  tumors  and 
caries  of  the  maxillary  bones. 

Glacial  phosphoric  acid  is  employed  as  one  of  the 
ingredients  of  the  plastic  filling  material,  known  as  oxyphos- 
phate  of  zinc,  the  other  ingredient  being  the  white  oxide  of 
zinc. 

HYDROCHLORIC  ACID,   HCl. 

Properties. — Hydrochloric  or  muriatic  acid  is  nearly 
colorless  when  pure,  but  that  usually  found  in  the  shops  is  of 
a  pale  yellow  color,  being  contaminated  with  chlorine,  iron, 
and  other  substances.  It  is  volatile,  emitting  a  dense  white 
and  suffocating  vapor;   taste  very  acid  and  caustic. 

Actions. — Hydrochloric  acid  is  caustic,  escharotic,  and 
disinfectant.  The  diluted  acid  administered  internally  is 
tonic,  refrigerant,  and  astringent. 

Diluted  Hydrochloric  Acid  (ten  per  cent,  solution  of 
absolute  acid  and  water).     Dose,  rr^v-xx. 

Dental  Uses. — It  is  sometimes  a  useful  application  for 
treatment  of  ulceration  and  inflammation  of  the  mucous 
membrane  and^ums.  **The  strong  acid  is  employed  in  the 
laboratory  for  dissolving  zinc,  in  the  preparation  of  a  flux  for 
soldering  certain  metals." 

SEDATIVES. 

Sedatives  are  agents  which  exert  a  soothing  influence — that 
is,  diminish  pain — by  lessening  the  functional  activity  of 
organs. 

* Gorgas' "  Dental  Medicine." 


112  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

The  principal  agents  of  this  class  are  opium  and  aconite 
(see  Anodynes),  digitalis  (see  Tonics),  alcohol  (see  Stimu- 
lants), chloroform  (see  Anaesthetics),  etc. 


ANTIPYRETICS. 

Antipyretics  are  agents  which  reduce  the  temperature  of 
fever.  They  act  either  by  lessening  heat  production  or  by 
radiation  of  heat. 

The  most  prominent  of  this  class  are  antipyrine, 
quinine  (see  Tonics),  aconite,  alcohol  (by  increasing  heat 
radiation),  also  cold  bath,  ice  to  the  body,  etc. 

ANTIPYRINE,  C2oHi8Np2- 

Derivation. — Antipyrine  is  an  alkaloidal  product  of  the 
destructive  distillation  of  coal-tar  oil. 

Properties. — It  is  a  whitish,  crystalline  powder,  soluble 
in  water  (one-half  its  weight  of  hot  and  its  own  weight  of 
cold  water);  less  soluble  in  alcohol,  chloroform,  and  ether; 
is  slightly  bitter  and  odorless.  It  may  be  administered 
hypodermically  ;  is  non-irritant  to  the  stomach  or  the  tissues. 
When  combined  with  ferric  chloride  it  gives  a  bright-red 
color,  and  with  nitric  acid  a  beautiful  green  color. 

Actions. — Antipyrine  is  a  powerful  and  popular  antipy- 
retic, a  general  anodyne,  haemostatic,  and  also  possesses  mild 
anaesthetic  and  hypnotic  powers.  A  full  medicinal  dose 
(gr.  xxx)  produces  a  stimulant  stage  of  short  duration,  which 
is  soon  followed  by  profuse  sweating,  coolness  of  the  surface, 
slowed  pulse,  and  more  or  less  depression.  The  temperature 
in  fevers  is  reduced  from  2  to  lo  degrees  in  from  i  to  5  hours, 
according  to  the  size  and  continuance  of  the  dose.  In  health 
the  reduction  of  the  temperature  is  very  slight,  and  it  gives 


IRRITANTS.  113 

rise  to  slight  nausea  and  depression.  It  is  eliminated  by  the 
kidneys,  appearing  in  the  urine  a  few  hours  after  taking. 

''In  toxic  doses  its  principal  influence  is  exerted  upon  the 
blood,  altering  the  shape  of  the  red  blood  corpuscles,  sepa- 
rating the  haematin,  and  causing  decomposition  of  that 
fluid."* 

Dose,  for  adult,  gr.  v-xxx  ;  children,  gr.  j-x. 

Dental  Uses. — Antipyrine  may  be  employed  in  dental 
practice  forits  haemostatic,  anaesthetic,  and  anodyne  powers. 


IRRITANTS. 

Irritants  are  agents  which  produce  more  or  less  vascular 
excitement  or  inflammation.  They  may  be  either  chemical, 
mechanical,  or  nervous. 

Chemical  irritants  are  those  which  act  by  virtue  of 
their  affinity  for^  organic  tissue,  exciting  the  action  of  the 
capillaries,  and  causing  an  afflux  of  vascular  and  nervous 
power  to  the  part  to  which  they  are  applied.  Included  in  this 
class  are  iodine,  capsicum  (see  Stimulants),  turpentine,  am- 
monia (see  Stimulants),  etc. 

Mechanical  irritants  are  agents  or  means  that  cause 
lesions  or  inflammation  by  mechanical  operation.  Filling 
material  or  other  foreign  substance  being  forced  through  the 
apical  foramen  of  the  root  of  a  tooth  will  causes  sufficient  irri- 
tation to  produce  an  abscess;  and  cuts,  contusions,  etc.,  are 
included  in  this  class. 

Nervous  irritants  act  through  the  medium  of  the  nerves, 
as  nervous  shock,  depression,  or  sympathetic  inflammation. 


*  Potter's  *■  Materia  Medica." 


114     DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

lOblNE. 

Derivation. — Iodine  is  obtained  principally  from  marine 
plants,  though  it  occurs  in  cod-liver  oil  and  shell-fish  to  a 
limited  extent. 

Properties. — Iodine  is  a  n,on-metallic  element,  is  usually 
in  the  form  of  bluish-black  crystalline  plates  or  scales,  having 
a  metallic  lustre,  a  peculiar  odor,  hot,  acrid  taste,  and  is  of 
neutral  reaction.  It  volatilizes  at  a  low  temperature,  giving 
off  a  beautiful  purple  vapor,  is  slightly  soluble  in  water  (i  in 
7000),  readily  soluble  in  alcohol  and  ether  (i  in  12),  also  in  a 
solution  of  chloride  of  sodium  and  iodide  of  potassium. 

Principal  Preparations : — 

Tincture  of  Iodine,  8  per  cent,  in  alcohol.    Dose,  ttj^J-v. 

Compound  Tincture  of  Iodine  (iodine,  5  per  cent., 
potassium  iodide,  KI,  10  per  cent.,  and  water  85  per  cent.). 
Dose,  infij-x  diluted. 

Potassium  Iodide.     Dose,  gr.  v-xxx. 

Iodoform,  CHI3.     Dose,  gr.  j-v,  in  pill  form. 

Actions. — Iodine  in  its  elementary  state  is  an  irritant  to 
the  skin,  and  is  much  used  in  the  form  of  tincture  to  produce 
counter-irritation. 

Internally  in  small  doses  it  is  stimulant  and  tonic;  it 
excites  a  sensation  of  heat  or  burning  in  the  stomach,  and  in 
large  doses  acts  as  an  irritant  poison.  If  continued  for  any 
length  of  time,  iodine  induces  great  waste  and  rapid  elimina- 
tion of  waste  products,  causing  anaemia  and  depression. 

The  local  irritant  effect  is  diminished  when  combined 
with  potassium  ;  hence,  potassium  iodide  (aqueous  solution  of 
potassa  and  iodine)  is  usually  employed  for  internal  use, 
which  allows  the  administration  of  larger  doses  and  for  a 
greater  length  of  time. 

Toxicology. —  T/ie  antidote  for  iodine  is  starch,  forming 


IRRITANTS.  115 

an  iodized  starch,  which  should  then  be  evacuated  from  the 
stomach. 

Colorless  Iodine. — There  are  a  number  of  methods  for 
bleaching  iodine;  among  them  are  the  following  :  ist.  Add 
to  a  drachm  of  tincture  of  iodine  six  ounces  of  hot  water  and 
twelve  grains  of  phenol;  stir  with  a  glass  rod.  2d.  Iodine  is 
bleached  by  mixing  with  carbolic  acid  ;  this,  carbolate  of 
iodine,  combines  all  the  advantages  of  both  agents. 

Dental -Uses. — Iodine  is  a  very  valuable  agent  in  dental 
practice,  the  tincture  being  employed  locally  in  the  treatment 
of  periostitis,  inflammation  and  ulceration  of  the  gums,  fun- 
gous growths,  suppurating  pulps  of  teeth,  alveolar  abscess,  and 
for  ulcerations  of  the  mucous  membrane  ;  it  is  often  combined 
with  carbolic  acid,  and  for  dental  periostitis  it  is  generally 
combined  with  tincture  of  aconite;  this  combination  forms 
an  excellent  treatment  for  the  incipient  stages  of  this  affection, 
as  well  as  those  of  alveolar  abscesses. 

TURPENTINE. 

Derivation. — Turpentine  is  a  concrete,  oleo-resinous 
exudation  from  various  species  of  pine,  but  principally  from 
the  **  yellow  pine." 

Properties. — Turpentine  is  in  the  form  of  tough,  yellow- 
ish masses,  more  or  less  transparent,  inflammable,  having  a 
strong,  unpleasant  odor,  and  warm,  pungent  taste. 

It  is  composed  entirely  of  resin  and  the  essential  oil  known 
as  oil  of  turpentine,  CioHigO.  It  is  soluble  in  alcohol.  The 
oil  is  the  form  mainly  used. 

Actions. — Turpentine  is  a  stimulant,  diuretic,  antispas- 
modic, and  rubefacient  (counter-irritant),  and  antiseptic 
externally. 

Principal  Preparations  : — 

Oil  of  Turpentine,  Spirits  of  Turpentine,  a  volatile  oil 


Il6  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

distilled  from  turpentine.  Dose,  n;^v-xv  in  emulsion  as  a 
stimulant. 

Turpentine  Liniment. — Resin  cerate  (a  composition  of 
wax,  oil,  or  lard),  65  per  cent.,  oil  of  turpentine,  35  per  cent. 

Pitch  is  a  resinous  exudation  from  the  stem  of  certain 
pine,  fir,  and  spruce  trees.  It  melts  at  the  boiling-point  of 
water,  and  softens  by  the  heat  of  the  human  body.  It  is  of  a 
dark-brown  color,  and  possesses  a  well- known  odor  and 
taste.     It  is  used  principally  as  the  base  of  plasters. 

Dental  Uses. — Turpentine  may  be  used  in  dental  prac- 
tice for  its  rubefacient  and  antiseptic  properties. 


ASTRINGENTS. 

Astringents  are  agents  which  produce  contraction  and 
condensation  of  organic  tissues,  with  a  tendency  to  remove 
morbid  affections,  arrest  hemorrhage  and  excessive  secretions 
from  the  mucous  membrane.  They  are  divided  into  two 
classes,  known  as  vegetable  and  mineral. 

The  principal  vegetable  astringents  are  tannic  acid 
and  gallic  acid,  the  chief  element  of  these  being  tannin, 
while  the  mineral  asf?'inge7ifs  are  persalts  of  iron  (see  Tonics), 
alum,  sulphuric  acid,  nitric  acid,  etc. 

TANNIC   ACID,    C.^H.Pi^. 

Derivation. — Tannic  acid  is  obtained  from  nut  galls. 
Galls  are  the  excrescence  on  the  twigs  of  the  Dyer's  oak, 
grown  in  Asia  Minor  and  Persia,  caused  by  the  punctures 
and  deposited  ova  (s^%)  of  an  insect. 

Properties. — Tannic  acid  is  obtained  in  the  form  of  thin, 
yellowish  crystals,  inodorous,  very  soluble  in  water,  less  so  in 
alcohol  and  ether. 


ASTRINGENTS.  1  I  7 

Action. — Tannic  acid  is  the  most  powerful  of  all  vege- 
table astringents  and  styptics.  It  is  especially  active  upon 
albumin,  gelatin,  and  fibrin,  forming  therewith  insoluble 
tannates,  thus  protecting  the  parts  beneath  until  resolution 
occurs.      Dose,  gr.  j-xx,  in  pill. 

Dental  Uses. — Tannic  acid  is  a  very  valuable  agent  to 
the  dental  practitioner.  It  is  used  locally  in  the  treatment 
of  hemorrhage  following  the  extraction  of  teeth,  wounds  of 
the  mucous  membrane,  fungous  growth  of  the  tooth  pulp, 
hypertrophy  of  the  gums,  and  to  many  it  has  proven  bene- 
ficial in  the  treatment  of  sensitive  dentine,  a  strong  solution 
of  tannin  being  mixed  with  alcohol.  In  mercurial  salivation, 
the  powdered  tannic  acid,  moistened  with  water,  -will  check 
the  tendency  to  absorption  and  the  consequent  loosening 
of  the  teeth,  and  will  render  the  gums  firmer  and  more 
comfortable. 

Glycerite  of  Tannic  Acid  (tannin,  ^ij ;  glycerin,  ^viij), 
for  external  use. 

Ointment  of  Tannic  Acid  (tannin,  ^j ;  lard,  gj),  for 
application  to  ulcers,  etc. 

GALLIC  ACID,  C^H605. 

Derivation. — Gallic  acid  is  prepared  from  nutgalls.  The 
powdered  galls,*in  water,  are  left  to  the  action  of  the  atmos- 
phere, when  the  acid,  in  the  form  of  fine,  almost  colorless, 
crystals  are  deposited. 

Properties. — Gallic  acid  is  obtained  in  the  form  of  very 
fine,  silky,  and  almost  colorless  crystals.  It  is  slightly  soluble 
in  cold  water  (loo  parts),  and  rapidly  so  in  hot  water, 
glycerine,  or  alcohol.  It  has  a  slightly  acid  and  astringent 
taste. 

Action. — Gallic  acid  is  a  powerful  astringent,  styptic,  and 
disinfectant.      It   is  given  directly  for  internal  hemorrhage 


Il8  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

profuse  perspiration  (night  sweats),  and  excessive  expectora- 
tions of  phthisis  and  chronic  diarrhoea.  Dose,  gr.  v-xx,  in 
pill  form. 

Dental  Uses. — In  dental  practice  gallic  acid  may  be  used 
as  a  styptic  in  superficial  hemorrhages;  it  is  not  so  efficient, 
however,  as  tannic  acid.  It  is  employed  in  the  form  of  a 
gargle,  in  acute  inflammation  of  the  mucous  membrane,  etc. 
For  hemorrhage  following  extraction  of  teeth,  Dr.  Bartholo- 
mew claims  that  a  teaspoonful  of  gallic  acid  in  a  glass  of 
water,  internally  administered,  is  very  efficacious. 

ALUM. 

Source. — Alum  is  found  native  in  Italy,  in  the  neighbor- 
hood of  volcanoes.  It  is  also  obtained  from  aluminous  slate 
or  shale  by  roasting  and  exposure  to  the  air. 

Formula. — The  official  alum  (potassic-aluminic-sulphate) 
has  the  formula  K2AL24SO4-I-24H2O.  Dried  or  ''  burnt  alum  " 
has  the  water  of  crystallization,  24H2O,  driven  off  by  gentle 
heating,  which  leaves  it  in  the  form  of  a  soft,  white  powder. 

Properties. — Alum  is  a  white,  transparent  salt,  crystalliz- 
ing easily  in  octahedrons  (having  eight  equal  and  equilateral 
triangles).  It  dissolves  easily  in  hot  water,  and  by  about 
fifteen  times  its  weight  in  cold  water ;  is  insoluble  in  alcohol. 
It  possesses  an  astringent  and  sweetish  taste. 

Actions. — When  taken  internally  in  large  doses,  it  causes 
vomiting,  purging,  and  inflammation  of  the  gastro-mucous 
membrane.  As  an  emetic,  powdered  alum,  in  teaspoonful 
doses,  is  very  efficient.  Applied  locally,  it  is  an  excellent 
astringent  to  relaxed  or  bleeding  parts.  Dose,  in  powder  or 
solution,  gr.  x-xl  (29). 

Dental  Uses. — In  dental  practice,  alum  is  employed  as  a 
styptic  in  alveolar  hemorrhage,  superficial  hemorrhage  of  the 


STYPTICS    AND    HAEMOSTATICS.  II9 

mucous  membrane,  ulcers  of  the  mouth,  etc.  It  also  serves 
an  excellent  purpose  as  a  gargle  in  ulceration  and  sponginess 
of  the  gums. 

STYPTICS  AND  HEMOSTATICS. 

Styptics  are  agents  which  arrest  hemorrhage  by  local  ap- 
plication. They  are  divided  into  chemical  and  mechanical, 
according  to  their  action. 

Chemical  styptics  coagulate  the  exuding  blood,  and  at 
the  same  time  stimulate  the  tissues  to  contraction. 

The  principal  members  of  this  class  are,  tannic  and 
gallic  acids  (see  Astringents),  persulphate  of  iron — solution, 
subsulphate  of  iron — powdered  (see  Tonics),  and  alum  (see 
Astringents). 

Mechanical  styptics  are  agents  which  promote  clot  for- 
mations in  the  mouths  of  bleeding  vessels.  They  retard  the 
flow  by  detaining  the  blood  in  their  meshes,  or  absorb  it  until 
it  coagulates.        ^ 

The  principal  mechanical  styptics  are  spider's  web, 
plaster-of-Paris,  sandarach  varnish,  cotton,  etc. 

Haemostatics  are  agents  capable  of  arresting  hemorrhage 
by  internal  administration,  such  as  ergot,  antipyrine  (see  As- 
tringents), the  dihited  mineral  acids  (see  Tonics),  etc. 

ERGOT. 

Source. — Ergot  is  obtained  from  a  parasitic  fungi  replac- 
ing the  grain  of  rye.  It  is  a  diseased  state  of  the  grain, 
occasioned  probably  by  a  hot  summer  succeeding  a  rainy 
spring.  Corn  ergot  is  obtained  from  a  similar  growth  upon 
the  Indian  corn. 

Principal  Preparations  ; — 

Fluid  Extract  of  Ergot.     Dose,  3ss-ij. 

Extract  of  Ergot.     Dose,  gr.  j-xx. 


I20     DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

Medical  Properties  and  Actions. — Ergot  is  a  haemo- 
static, aiding  coagulation  by  slowing  the  blood  current.  It  is 
also  used  to  stimulate  the  contraction  of  unstriped  muscular 
fibre,  particularly  those  of  the  uterus,  causing  continuous  labor 
pains.  It  has  been  much  used  for  this  purpose  in  obstetrics, 
and  very  often  injuriously,  causing  laceration  of  the  perineum 
and  paralysis  of  the  foetal  heart,  the  natural  intermitting  con- 
traction being  the  most  desirable. 

Dental  Uses. — Ergot  may  be  used  in  dental  practice  for 
its  haemostatic  properties  in  alveolar  or  other  hemorrhages. 


ESCHAROTICS  OR  CAUSTICS. 
Escharotics  or  caustics  are  agents  which  are  capable  of 
destroying  the  life  of  the  tissue  with  which  they  come  in  con- 
tact, producing  an  eschar  or  sloughing  of  the  tissue.  Fire 
itself  is  the  actual  cautery,  while  the  potential  cautery  (caustic 
substances)  is  represented  by  silver  nitrate,  arsenious  acid  (see 
Tonics),  carbolic  acid,  zinc  chloride  (see  Tonics),  and  the 
mineral  acids  (see  Tonics),  etc. 

NITRATE  OF  SILVER,  AgNOj. 

Derivation. — Nitrate  of  silver,  or  "lunar  caustic,"  is 
made  by  dissolving  silver  in  nitric  acid,  and  evaporating  the 
solution.  The  reaction  being  Agg  -j-  4HNO3  =  3AgN03  -}- 
2U,0  +  NO. 

Properties. — Nitrate  of  silver  is  in  the  form  of  colorless, 
shining  crystals,  but  is  readily  blackened  by  mixing  with  or- 
ganic matter  or  by  exposure  to  the  light,  is  very  soluble  in 
water,  and  has  a  strong  metallic  and  styptic  taste.  It  is  often 
cast  in  sticks,  by  first  being  melted  (fusing  at  426°F.)  and 
then  poured  into  suitable  moulds. 

Actions. — Nitrate    of  silver    is   a   powerful    caustic   and 


ESCHAROTICS    OR    CAUSTIC.  121 

astringent,  a  heart  and  nerve  stimulant,  antispasmodic  and 
sedative.  When  applied  locally  to  the  mucous  membrane, 
ulcers,  etc.,  it  first  turns  the  surface  white,  owing  to  its  union 
with  the  coagulated  albumin,  but  finally  turns  to  a  black 
color,  which  is  due  to  the  partial  reduction  of  the  silver  by 
the  sulphuretted  hydrogen  contained  in  the  atmosphere. 
Co7itijii{ed  tese  of  nitrate  of  silver  will  cause  a  peculiar  blue  line 
in  the  gums,  similar  to  that  from  lead  poisoning;  this  is  fol- 
lowed by  a-  blue  appearance  of  the  skin.  The  remedy  should 
be  discontinued  at  once  when  this  discoloration  is  observed. 

Dose  of  nitrate  of  silver,  gr.  ^  gradually  increased  to 
gr.  j,  in  pill  form.  Never  should  be  given  with  tannin  or  a 
vegetable  extract ;  an  explosive  compound  may  result.  The 
fused  or  solid  form  is  used  externally. 

The  antidote  for  nitrate  of  silver  is  chloride  of  sodium 
(common  salt)  freely;  it  precipitates  it  in  the  insoluble  chlo- 
ride of  silver ;   also  acts  as  an  emetic. 

Dental  Us^s. — Nitrate  of  silver  is  employed  in  dental 
practice  for  obtunding  sensitive  dentine,  especially  where  the 
cause  is  mechanical  abrasion,  or  from  the  fracture  of  a  .tooth, 
exposing  the  healthy  and  sensitive  dentine,  the  stick  form 
being  employed,  or  the  end  of  a  silver  wire  may  be  immersed 
in  nitric  acid  aiyi  carefully  applied.  It  is  also  a  valuable  ap- 
plication for  ulcerated  conditions  of  the  mucous  membrane  of 
the  mouth,  also  as  a  treatment  for  caries  in  deciduous  teeth. 

CARBOLIC  ACID,  CgH^O. 
Derivation. — Carbolic  acid,  phenylic  alcohol  or  phenol, 
is  obtained  as  an  alcoholic  product  of  the  distillation  of  coal 
tar,  between  the  temperatures  of  338°  and  370°  F.  Carbolic 
acid,  though  the  universal  name,  is  inappropriate.  It  does 
not  belong  to  the  acid  series  (it  will  not  turn  blue  litmus  paper 
red),  being  neutral  in  its  reaction. 
9     - 


122  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Properties. — Carbolic  acid,  when  pure,  is  in  the  form  of 
colorless  or  pinkish  acicular  (needle-like)  crystals.  It  becomes 
an  oily  liquid  at  95°  F. ,  or,  if  exposed  to  the  air,  the  crystals 
readily  absorb  moisture  and  are  thus  liquefied.  Five  per  cent, 
of  water  liquefies  it ;  any  further  addition  simply  forms  a 
mechanical  mixture.  It  is  freely  soluble  in  alcohol,  ether, 
chloroform,  glycerine,  and  the  essential  oils.  It  has  a  strong 
aromatic  odor  and  taste,  resembling  creasote  somewhat. 

Actions. — Carbolic  acid  in  its  pure  state  is  escharotic ; 
when  diluted,  it  is  a  powerful  antiseptic,  germicide,  rubefa- 
cient, and  is  a  violent  poison  ;  internally,  it  is  a  sedative  and 
carminative,  allaying  vomiting  and  gastric  irritability. 

It  resembles  creasote  closely  in  many  of  its  medicinal  prop- 
erties, but  is  probably  more  efficacious,  and  its  odor  is 
surely  less  objectionable ;  the  use  of  creasote  by  the  dental 
practitioner  may  therefore  well  be  discarded. 

Dose,  gr.  ^,  for  relief  of  nausea,  etc. 

Dental  Uses. — Carbolic  acid  is  a  valuable  agent  in  dental 
therapeutics,  it  being  one  of  the  best  escharotics,  styptics, 
antiseptics,  sedatives,  etc.  It  is  used  to  obtund  sensitive  den- 
tine, to  relieve  odontalgia,  when  caused  by  the  exposure  of 
the  tooth  pulp,  by  applying  it  to  the  exposed  surface;  it 
arrests  putrefactive  changes,  is  a  valuable  agent  in  the  treat- 
ment of  alveolar  abscess  ;  is  also  used  to  bathe  cavities  in  the 
teeth,  both  for  its  obtunding  effect  upon  the  sensitive  dentine 
and  to  destroy  any  low  organisms  that  may  be  in  the  softened 
dentine. 

In  a  form  known  as  phenol  sodique,  carbolic  acid  is 
very  useful  as  a  styptic  for  the  treatment  of  superficial  hemor- 
rhage after  the  extraction  of  teeth,  and  forms  an  excellent 
antiseptic  mouth-wash. 

"Combined  with  glycerine  (i  part  to  12  of  glycerine)  it 
will   stimulate  the    mucous   secretion,  and    hence  has  been 


ESCHAROTICS    OR    CAUSTICS.  1 23 

applied  to  the  palate,  in  cases  of  deficiency  of  this  secretion, 
to  promote  the  suction  of  upper  dentures."  * 

ACETIC  ACID,  C2H^02. 

Derivation. — Acetic  acid  is  produced  from  wood  by 
destructive  distillation. 

Properties  and  Actions. — The  purified  acid  contains 
about  28  per  cent,  of  anhydrous  acetic  acid.  The  dilute  acid, 
the  only  form  employed  internally,  is  composed  of  one  part 
acetic  acid  to  seven  parts  distilled  water. 

It  is  a  stimulant,  astringent,  diaphoretic,  escharotic,  etc. 
The  strong  acid,  when  applied  to  the  skin,  causes  considerable 
redness  and  pain,  which  rapidly  results  in  a  blister  (vesica- 
tion). 

Dose. — Acetic  acid,  dilute,  3J-ij. 

Therapeutic  Uses. — Acetic  acid  is  sometimes  employed 
in  fevers,  night-sweats,  hemorrhage  of  the  lungs  or  stomach. 
Externally,  the^trong  acid  is  used  in  the  treatment  of  cancer, 
corns,  warts,  or  fungous  growths.  The  dilute  acid  is  some- 
times employed  externally  to  gangrene,  ulcers,  and  sprains  or 
bruises. 

Dental  Uses. — Acetic  acid  is  sometimes  applied  to  indo- 
lent ulcers  of  the  mouth,  and  to  fungous  growths  of  gum  or 
dental  pulp ;  for  the  latter  the  concentrated  form  is  em- 
ployed. Gorgas  gives  the  following  formula  for  indolent 
ulcers,  cancrum  oris,  etc.  :  Acetic  acid  three  fluid  ounces  to 
distilled  water  five  fluid  ounces;  apply  with  camel's-hair 
brush. 

TRICHLORACETIC  ACID. 

Derivation. — Trichloracetic  acid  is  formed   from  acetic 

acid,  three  atoms  of  the  hydrogen  of  which    is,  in   the   new 

*  Prof.  Gorgas. 


124  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

acid,  replaced  by  chlorine.  It  is  one  of  a  group  of  three 
acids,  having  similar  properties  ;  the  difference  in  their  com- 
position is  due  to  the  proportion  of  chlorine  they  contain. 
The  others  referred  to  are  monochloracetic  and  dichloracetic 
acids. 

Properties  and  Actions. — Trichloracetic  acid  is  in  the 
form  of  colorless,  deliquescent  crystals,  having  an  agreeable 
odor,  and  is  readily  soluble  in  water  and  alcohol.  Its  con- 
centrated solutions  are  powerful  caustics,  while  the  weaker 
solutions  make  a  good  antiseptic. 

Therapeutic  Uses. — As  an  antiseptic  it  is  used  in 
putrid  and  indolent  wounds  and  erysipelas.  Diluted  with 
water  to  a  3  per  cent,  strength  it  is  an  effective  stimulant 
and  astringent. 

Dental  Uses. — It  is  used  in  dental  practice  as  an 
escharotic ;  10  per  cent,  solution  is  often  employed  in  the 
treatment  of  pyorrhoea  alveolaris,  acting,  it  is  claimed,  as  a 
solvent  on  calculi  upon  the  roots  of  teeth.  A  one  per  cent, 
solution  is  recommended  as  a  mouth-wash,  owing  to  its 
astringent  and  stimulating  qualities. 

ANTIZYMOTICS. 

Antizymotics  are  agents  which  arrest  or  prevent  fer- 
mentative processes ;  they  are  divided  into  antiseptics  and 
disinfectants. 

Antiseptics  are  those  agents  which  prevent  or  retard 
septic  decomposition,  either  by  destroying  the  bacteria  upon 
which  putrefaction  depends,  or  by  arresting  their  development. 

The  most  important  of  this  group  are  bichloride  of 
mercury,  peroxide  of  hydrogen,  carbolic  acid  (see  Escha- 
rotics),  potassium  permanganate,  iodoform,  phenol  sodique, 
alcohol,  eucalyptol,  etc. 


ANTIZYMOTICS.  1 25 

Disinfectants  are  those  agents  which  destroy  the  germs 
of  infectious  diseases. 

The  principal  members  of  this  group  are  carbolic  acid 
(see  Escharotics),  zinc  chloride  (see  Tonics,  Zinc),  potassium 
permanganate,  iodine  (see  Irritants),  aromatic  sulphuric  acid 
(see  Tonics, — Sulphuric  Acid). 

BICHLORIDE  OF  MERCURY,  HgCl^. 

Derivation. — Bichloride  of  mercury,  mercuric  chloride, 
or  *' corrosive  sublimate,"  is  obtained  by  distilling  *  a  mix- 
ture of  sodium  chloride  and  mercuric  sulphate ;  a  double 
decomposition  takes  place,  forming  mercuric  chloride  and 
sodium  sulphate. 

Properties. — Bichloride  of  mercury  is  in  the  form  of  col- 
orless crystalline  masses.  It  is  inodorous,  fusible,  soluble  in 
16  parts  of  water,  7  parts  of  alcohol  and  ether,  and  has  an 
acrid,  styptic  taste. 

Actions. — Bichloride  of  mercury  is  one  of  the  most  active 
salts  of  mercury.  It  is  one  of  the  most  efficient  of  all  the 
antizymotics  in  the  strength  of  i  part  to  2000  parts  of  water. 
It  is  internally  employed  in  chronic  diarrhoea,  dysentery,  and 
syphilis. 

Dose,  gr.  -sV^^o"  ^'"^  pi^^  form. 

Antidotes  to  bichloride  of  mercury  are  albumin, 
wheat  flour,  milk,  etc. 

Dental  Uses. — For  prophylactic  treatment  of  the  oral 
cavity,  particularly  of  the  teeth,  bichloride  of  mercury,  i  to 
10,000,  is  most  effective.  It  should  be  carefully  used,  how- 
ever, on  account  of  its  poisonous  character. 

It  is  also  used  extensively  in  dental  practice,  in  treatment 

*  The  double  process  of  vaporization  and  condensation  of  the  vapor. 


126  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

of  alveolar  abscesses,  and  in  diseases  of  the  antrum  of  High- 
more,  in  a  solution  of  i  to  2000,  to  i  to  5000. 

PEROXIDE  OF  HYDROGEN,  Hfi^. 
Derivation. — Peroxide  of  hydrogen  is  obtained  by  com- 
bining an  extra  molecule  of  oxygen  with  hydrogen  monoxide, 
H2O  (water),  the  result  being  a  water-like  liquid,  H2O2. 
**  As  when  barium  dioxide  is  dissolved  in  dilute  hydrochloric 
acid  :  — 

BaO^  +  2HCI  +  H2O  =  BaCl2  -f-  H2O  -f  H2O2."  * 

Properties. — Peroxide  of  hydrogen  is  in  the  form  of  a 
colorless,  transparent  liquid,  is  inodorous,  and  almost  tasteless. 

Actions. — Peroxide  of  hydrogen  is  one  of  the  most  effi- 
cient and  at  the  same  time  the  least  harmful  of  all  antiseptics 
and  disinfectants.  The  second  molecule  of  oxygen,  spoken 
of  above,  is  very  loosely  combined,  and  the  mixture  is  always 
on  a  strain  to  break  up  into  water  and  oxygen  ;  for  this  reason 
it  should  always  be  kept  in  a  cool  and  dark  place,  and  it  is 
owing  to  this  fact  (that  peroxide  of  hydrogen  generates 
**  ozone,"  O3)  that  pus  and  the  bacteria  of  diseased  surfaces, 
when  treated  with  this  agent,  are  at  once  destroyed.  '*As 
soon  as  ozone  has  accomplished  its  cleansing  effects  upon  the 
infected  surface,  it  is  readily  transformed  into  ordinary 
oxygen,  owing  to  its  instability."  //  is  employed  as  an  in- 
ternal remedy  in  fevers,  whooping  cough,  bronchitis,  con- 
sumption or  phthisis,  diphtheria,  dyspepsia,  catarrh  of  the 
stomach,  etc. 

Locally  Employed. — Peroxide  of  hydrogen  may  be  em- 
ployed for  its  antiseptic  and  pus-destroying  properties  in  the 
treatment  of  abscesses,  ulcers,  carbuncles,  wounds,  both  fresh 


*Leffmann's  "Chemistry. 


ANTIZYMOTICS.  I27 

and  putrid,  catarrh  of  the  nose,  hay  fever,  diphtheria,  etc.  It 
is  also  the  base  of  most  hair-bleaching  solutions. 

Dose  of  peroxide  of  hydrogen,  3ss-ij. 

Dental  Uses. — It  is  one  of  the  most  valuable  remedies  in 
dental  therapeutics,  being  especially  valuable  as  a  cleansing 
agent,  and  is  employed  also  in  the  treatment  of  alveolar 
abscesses,  pyorrhoea  alveolaris,  inflammation  and  ulceration 
of  the  oral  mucous  membrane,  fungous  growths,  etc. 


PYROZONE. 

Derivation. — Pyrozone  solutions  are  aqueous  or  ethereal 
fluids,  containing  exact  percentages  of  hydrogen  peroxide. 
The  solutions  are  prepared  in  two  strengths,  aqueous  3  per 
cent,  solution,  and  ethereal  25  per  cent,  solution. 

Properties  and  Actions. — Pyrozone  3  per  cent,  solu- 
tion is  a  rapidly  acting,  harmless  antiseptic,  which  can  be 
employed  externally  or  internally  without  danger  of  toxic 
effects.  It  may  be  used  in  all  cases  where  carbolic  acid  or 
other  disinfectant  is  indicated.  The  25  per  cent,  solution  is 
a  bleaching  agent,  and  when  applied  to  diseased  parts  acts  as 
a  powerful  caustic,  bringing  about  resolution  in  a  short  time. 

Therapeutic  Uses. — The  3  per  cent,  solution  is  used  in 
certain  forms  ^f  indigestion  or  dyspepsia,  ulcers  of  the 
stomach,  and  gastritis  ;  25  per  cent,  solution  is  applied  to 
ulcers,  syphilitic  patches,  pus-generating  surfaces,  and  for 
chronic  eczema. 

Dental  Uses. — Pyrozone  is  used  in  the  3  per  cent,  solu- 
tion as  a  mouth-wash ;  it  is  non-poisonous,  and  in  cases  where 
the  micro-organisms  of  the  mouth  threaten  septic  invasion  of 
the  stomach,  it  forms  a  perfect  gargle  or  spray.  It  completely 
destroys  pus  and  mucous  secretions,  and  renders  the  mouth 
aseptic.      The  25  per  cent,  solution  is,  as  has  been  indicated. 


128  DKNTAL    PATHOLOGY    a'nD    DENTAL    MEDICINE. 

employed  principally  as  a  bleaching  agent,  and  is  proving  a 
most  valuable  drug  for  that  purpose. 

PEROXIDE  OF  SODIUM. 

Derivation. — Sodium  peroxide  is  obtained  by  adding 
hydrogen  peroxide  to  an  excess  of  caustic  soda,  20  per  cent, 
solution,  whicli  is  then  poured  into  alcohol. 

Properties  and  Actions. — Sodium  peroxide  is  the 
chemical  analogue  of  hydrogen  peroxide,  and  is  dispensed 
as  a  yellowish  white  powder,  which  is  soluble  in  water,  which 
action  produces  an  increase  in  temperature  and  evolves  a  cer- 
tain amount  of  oxygen.  It  is  a  strong  caustic  alkaline,  which 
properties'  it  retains  after  the  loss  of  part  of  its  oxygen,  be- 
coming NaaO,  which, -in  combination  with  water,  is  ordinary 
caustic  soda. 

Dental  Uses. — It  is  used  in  dental  practice  as  a  bleach- 
ing and  sterilizing  agent.  It  is  claimed  that  sodium  peroxide 
removes,  more  completely  than  any  other  drug,  the  dental 
tubular  contents  ;  and  it  is  further  claimed  that  the  normal 
translucency  of  the  tooth  is  more  fully  restored. 

PERMANGANATE  OF  POTASSIUM,  K2Mn208. 

Derivation. — Permanganate  of  potassium  is  prepared  by 
fusing  the  black  oxide  of  manganese  with  chlorate  of  potas- 
sium and  caustic  potassa. 

Properties. — It  is  in  the  form  of  dark  purple  crystals;  it 
is  very  soluble  in  water,  forming  a  beautiful  lilac-colored 
solution  ;  inodorless,  and  has  a  sweetish,  astringent  taste. 

Actions. — Permanganate  of  potassium  taken  internally  is 
a  stimulant,  and  is  given  with  benefit  in  dyspepsia;  is  a  mild 
escharotic,  and  a  powerful  disinfectant  and  deodorizer.  The 
solution  is   decomposed    by  organic    matters,  sulphides   and 


ANTIZYMOTICS.  1 29 

sulphites,  yielding  up  its  oxygen  readily  (on  which  property 
its  use  depends),  and  is  converted  into  a  colorless  solution. 

The  most  important  uses  for  this  agent  are  external, 
where  it  is  employed  as  a  deodorizer  and  disinfectant  in 
abscesses,  ulcers,  cancers,  caries  of  the  bone,  etc.,  in  the  form 
of  a  lotion  and  spray,  while  the  powder  may  be  sprinkled  on 
gangrenous  surfaces,  acting  as  a  local  stimulant  as  well  as  a 
deodorizer. 

Dose,  for  internal  use,  gr.  }(-].  For  external  use,  f5j  to 
water,  f^v-x. 

Dental  Uses. — It  is  employed  in  dental  practice  in  the 
treatment  of  foul  abscess,  in  diseases  of  the  antrum,  necrosis 
of  the  maxillary  bones,  ulcers  of  the  mouth  attended  with 
fetid  discharges,  offensive  breath,  etc. 

IODOFORM,  CHI3. 

Derivation. — Iodoform  is  a  preparation  of  iodine.  It  is 
''obtained  by  the  action  of  chlorinated  lime  upon  an  alco- 
holic solution  of  iodide  of  potassium,  heated  at  104°  F. ,  the 
product  being  iodoform  and  iodate  of  lime,  the  iodoform 
being  separated  by  boiling  alcohol." 

Properties. — Iodoform  is  in  the  form  of  small  yellow 
crystals,  which  are  soft  to  the  touch,  of  a  sweetish  taste;  is 
volatile,  and  has  a  very  unpleasant  odor  (which  may  be 
covered  with  oil  of  rose,  etc.)  ;  is  insoluble  in  water,  but  is 
soluble  in  alcohol,  ether,  chloroform,  and  the  essential  oils. 

Actions. — Iodoform  is  an  efficient  antiseptic,  inhibiting 
and  destroying  the  microbes  of  putrefaction  and  suppuration  ; 
it  has  also  slight  local  anaesthetic  properties. 

Internally  in  small  doses  it  is  a  tonic,  alterative, 
anodyne,  and  antiseptic. 

In  large  doses  it  causes  a  form  of  intoxication,  followed 
by  convulsions,  collapse,  and  death. 


T30  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

Dose,  gr.  j-v,  in  pill  form. 

Dental  Uses. — In  dental  practice  iodoform  is  a  valuable 
agent;  it  is  an  excellent  antiseptic  for  the  treatment  of 
alveolar  abscesses,  putrescent  pulps,  especially  when  com- 
bined with  oil  of  eucalyptus.  Prof.  Peirce  recommends  iodo- 
form ground  with  equal  parts  of  oil  of  cloves  and  oil  of 
eucalyptus,  a  portion  of  which  may  be  introduced  to  the 
inflamed  part  on  the  point  of  a  small  broach. 

Iodoform  is  also  serviceable  as  a  packing  for  the  pockets  of 
pyorrhoea  alveolaris,  and  as  a  dressing  or  packing  for  wounds, 
where  it  may  be  used  in  the  powdered  form  or  in  the  form  of 
a  gauze  which  is  prepared  for  the  purpose. 

ARISTOL. 

Derivations. — Aristol  is  a  preparation  of  iodine,  and  has 
gained  a  position  in  recent  therapeutics  as  a  perfect  substitute 
for  iodoform.  It  is  a  thymol  iodide,  and  is  ''produced  by 
treating  an  aqueous  solution  of  iodine  in  iodide  of  potassium 
with  an  aqueous  solution  of  thymol  in  the  presence  of  caustic 
potash." 

Properties. — Aristol  is  in  the  form  of  a  reddish  brown 
powder ;  is  volatile,  and  has  a  slight  aromatic  odor,  though 
when  compared  with  iodoform  we  may  say  it  is  practically 
inodorous.  The  quantity  of  iodine  contained  in  it  is  from 
45  to  50  per  cent. 

Aristol  is  insoluble  in  water  and  glycerine,  slightly  soluble 
in  alcohol,  but  is  readily  soluble  in  ether,  chloroform,  collo- 
dion, and  the  fixed  and  ethereal  oils. 

Actions. — Aristol  is  an  efficient  antiseptic  ;  it  is  particu- 
larly applicable  as  a  dressing  for  wounds,  ulcerations,  and 
abrasions  of  the  skin  and  mucous  membrane. 

It  may  be  dusted  over  the  wound,  or  applied  in  the  form 
of  aristol  ointments  (compounds  of  vaseline  or  cold  cream) 


ANTIZYMOTICS.  I3I 

or  in  combination  with  collodion.  All  of  these  are  excellent 
and  easy  of  application.  Its  efficiency  as  an  antiseptic  and 
alterative  is  largely  due  to  the  fact  that  it  slowly  gives  off  its 
iodine,  and  it  is  also  due  to  this  fact  that  it  does  so  decom- 
pose, when  exposed  to  the  light  or  undue  heat,  that  it  should 
be  kept  in  a  colored  bottle  or  a  closed  box  and  in  not  too 
warm  a  place.  If  this  is  not  done,  the  loss  of  iodine  will  be 
readily  noticed  by  its  gradually  becoming  paler  in  color. 

Dental.  Uses. — Aristol  is  a  welcome  addition  to  our 
catalogue  of  therapeutic  agents.  I  have  found  it  an  excellent 
agent  for  treating  root-canals  from  which  putrescent  pulps 
have  been  removed  and  for  alveolar  abscesses.  It  can  also  be 
used  advantageously  in  combination  with  root-filling  materi- 
als ;  it  may  be  used  by  mixing  the  powder  with  chloro-percha, 
or,  where  gutta-percha  cones  are  to  be  used,  the  cone  may  be 
dipped  in  a  solution  of  aristol  and  chloroform  and  immediately 
carried  to  position.  Dr.  Kirk  says  of  it  in  this  connection  : 
*'I  have  made  use  of  aristol  in  connection  with  root-filling 
materials  by  another  method.  A  strong  solution  of  aristol  is 
made  in  the  oil  known  to  house-painters  as  '  Japan  dryer,' 
sufficient  of  the  drug  being  added  to  make  the  liquid  some- 
what thinner  than  glycerine;  into  this  is  worked  with  a 
spatula  freshly  calcined  oxide  of  zinc  until  the  mass  is  like 
putty,  in  which  condition  it  is  to  be  worked  into  the  root- 
canals.  The  mass  becomes  quite  hard,  and  seems  to  fulfill 
admirably  the  requirements  of  a  root-filling." 

FORMALIN. 
Derivation. — The  name  formalin  has  been  given  to  a  40 
per  cent,  solution  of  chemically  pure  formaldehyde  in  water. 
Formaldehyde  (CH2O),  as  is  well  known,  is  a  gaseous  body 
which  is  prepared  by  subjecting  methyl-alcohol  to  oxidation. 
It  is  readily  absorbed  by  water  ;   for  this  reason  it  is  put  on 


132  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

the  market  in  the  form  of  an  aqueous  solution  termed 
"formalin."  It  mixes  with  water  in  all  proportions,  making 
it  easy,  therefore,  to  prepare  any  dilution  required. 

Properties  and  Actions. — Formalin  can  be  used  either 
in  a  gaseous  or  liquid  form  ;  it  is  non-poisonous,  of  a  peculiar, 
penetrating  odor.  When  brought  into  contact  with  the 
animal  skin,  undiluted  formalin  exerts  a  kind  of  tanning 
effect,  making  the  skin  impermeable  and  finally  brings  about 
necrosis.  The  tissue  is  destroyed  with  suppuration  or  forma- 
tion of  a  wound. 

Therapeutic  Uses. — Formalin  is  an  ideal  germicide, 
disinfectant,  deodorant,  and  antizymotic,  possessing  the  same 
germicidal  power  as  corrosive  sublimate,  without  its  toxicity. 
It  is  used  in  aseptic  and  antiseptic  surgery,  for  inhalations,  in 
ophthalmic  practice,  in  bacteriology,  as  a  hardening  and 
preserving  medium,  and  in  the  recognization  of  the  typhoid 
bacillus. 

Dental  Uses. — It  may  be  used  in  dentistry  to  kill  the 
nerves  of  teeth,  and  as  an  antiseptic  agent. 

GAULTHERIA. 

Derivation. — Gaultheria  is  obtained  from  the  leaves  of 
the  gaultheriae  procumbens  {Ericacece),  a  small  plant  common 
to  North  American  woods.  These  leaves  contain  tannic 
acid,  urson,  arbutin,  ericolin,  a  volatile  oil,  etc. 

Properties  and  Actions. — Gaultheria  has  an  aromatic, 
bitter,  and  astringent  taste.  The  volatile  oil  is  composed 
principally  of  methyl  salicylate  and  gaultherilene,  which  pro- 
duce pure  salicylic  acid. 

Therapeutic  Uses. — The  oil  of  gaultheria  is  antipyretic 
and  antiseptic,  and  is  used  in  wounds,  and  administered  in- 
ternally for  articular  rheumatism.  The  spirit  of  gaultheria  is 
used  as  a  flavoring  extract. 


ANTIZYMOTICS.  1 33 

Dental  Uses. — Gaultheria,  being  one  of  the  essential  oils, 
is  useful  to  the  dentist  for  its  antiseptic  properties,  either 
alone  or  combined  with  other  medicines  for  the  treatment  of 
alveolar  abscess  and  putrid  root-canals;  it  is  also  an  ingredient 
of  local  anaesthetic  mixtures. 

CREASOTE. 

Derivation. — Creasote  is  one  of  the  products  of  the 
distillation'  of  wood-tar,  and  consists  principally  of  such 
phenols  as  phloral,  creasol,  methyl-creasol,  and  guaiacol.  It 
can  also  be  obtained  from  crude  pyroligneous  acid.  That 
made  from  beech-wood,  however,  is  the  better  form  for 
medicinal  use. 

Properties  and  Actions. — Creasote  is  a  colorless,  oily 
fluid,  with  an  odor  somewhat  resembling  carbolic  acid,  and 
has  a  burning  taste.  It  is  a  stimulant,  antiseptic,  styptic, 
sedative,  and  rubefacient.  In  large  doses  it  is  a  narcotic 
poison,  causing  death  by  coagulating  the  albumen  of  the 
blood,  preventing  its  circulation  through  the  arteries. 
It  is  used  in  small  doses,  generally,  for  its  astringent 
qualities. 

Therapeutic  Uses. — Internally,  creasote  is  administered 
for  pulmonarjr  consumption,  chronic  bronchitis,  vomiting  and 
gastric  troubles,  diarrhoea,  diabetes,  etc.  Externally,  applied 
to  hemorrhage  from  wounds,  etc.,  diseases  of  the  skin,  erup- 
tions, ulcers,  etc. 

Dental  Uses. — Creasote  has  for  many  years  been  em- 
ployed in  dental  practice  for  relieving  odontalgia,  as  an 
obtundent,  for  alveolar  abscess,  ulcers  of  the  mouth,  etc. 
Its  antiseptic  powers  render  it  valuable  for  offensive  puru- 
lent discharges;  and  its  styptic  properties  are  sometimes 
taken  advantage  of  in  the  treatment  of  hemorrhage  after 
extraction  of  teeth. 


134  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

NAPHTHOL. 

Derivation. — Naphthol  is  derived  from  naphthalene 
(CioHg),  which  is  a  coal-tar  product  and  in  the  form  of  white 
crystals,  liaving  a  strong,  unpleasant  odor;  soluble  in  alcohol, 
but  not  in  water.  This  alcoholic  solution  is  known  as 
naphthol. 

Properties  and  Action. — There  are  two  forms  of 
naphthol,  a-naphthol  and  /3-naphthol ;  the  latter,  owing  to 
its  less  irritating  effects,  is  generally  employed  medicinally. 
It  is  a  light-brown  crystal,  soluble  in  hot  water. 

Therapeutic  Uses. — Owing  to  its  antiseptic  properties, 
it  is  used  in  parasitic  diseases  of  the  skin  ;  it  is  given  in- 
ternally, and  applied  externally  as  an  ointment. 

Dental  Uses. — Hydronaphthol,  supposed  to  be  a  form 
of  /9-naphthol,  is  most  generally  used  in  dental  practice  for 
treating  canals  of  pulpless  teeth,  pericemental  inflammation 
of  septic  origin,  especially  in  early  stages  before  pus  has 
formed.  Professor  James  Truman  recommends  a  solution  of 
1  :  looo  of  water  for  injection  into  pulp  canals.  It  is  also 
recommended  as  an  ingredient  for  a  mouth-wash  for  diseased 
gums  and  mucous  membrane. 

CAMPHO-PHENIQUE,  C^H^fi. 

Derivation. — Campho-phenique  is  obtained  from  the 
chemical  union  of  carbolic  acid  and  camphor.  It  is  prepared 
as  follows:  Nine  parts  of  carbolic  acid  to  one  part  of  alcohol 
are  mixed  with  twenty-five  parts  camphor.  The  clear  oily 
solution  is  the  result. 

Properties  and  Actions. — Campho-phenique  is  a  limpid, 
volatile  fluid,  having  an  aromatic  taste  and  the  odor  of  camphor. 
It  is  an  antiseptic,  a  mild  local  anaesthetic,  and  germicide ;  is 
non-irritant,  non-poisonous ;  insoluble  in  water  or  glycerine, 


ANTIZYMOTICS.  ,  135 

but  will  mix  in  all  proportions  with  alcohol,  ether,  or  chlo- 
roform. 

D-ental  Uses. — As  a  dressing  in  the  treatment  of  putres- 
cent pulp-canals  it  has  given  quite  satisfactory  results.  It  has 
been  employed  hypodermically  as  a  local  anaesthetic,  causing 
no  constitutional  disturbance.  It  is  also  recommended  for 
the  relief  of  pain  following  the  extraction  of  teeth,  in  which 
case  it  is  introduced  into  the  sockets  upon  pledgets  of  cotton. 

CINNAMON  (Cassia  Bark). 

Source. — The  commercial  cinnamon  is  the  prepared  bark 
of  a  tree  of  the  natural  order  LauracecE.  The  best  varieties  of 
this  bark  are  obtained  from  Ceylon.  It  contains  a  volatile  oil, 
an  acid  peculiar  to  itself, — cinnamic  acid, — a  trace  of  tannic 
acid,  mucilage,  etc. 

Properties  and  Actions. — Cinnamon  is  placed  upon 
the  market  in  the  form  of  long,  thin,  cylindrical  pieces, 
having  a  yellow-brown  color,  a  fragrant  odor,  and  a  sweetish, 
aromatic,  and  mildly-astringent  taste.  It  is  more  powerful  as 
a  local  than  as  a  general  stimulant.  Its  medicinal  virtues, 
however,  reside  in  a  volatile  oil,  oleum  cinnamomi,  or  oil  of 
cinnamon. 

Therapeutics. — Cinnamon  is  sometimes  employed  to 
allay  nausea  and  vomiting,  and  in  combination  with  chalk 
and  with  other  astringents  it  is  used  for  the  treatment  of  diar- 
rhoea. The  oil  of  cinnamon  is  often  employed  to  conceal  the 
taste  of  other  medicines,  and  is  a  strong  local  stimulant. 

Oil  of  Cassia. — Oil  of  cassia  is  prepared  from  the  bud 
of  the  same  order  of  tree,  and  the  oil  of  cinnamon  from  the 
bark.  The  oil  of  cassia  is  preferred  by  many  as  an  antiseptic 
for  local  treatment. 

Dental  Uses. — Oil  of  cinnamon  and  oil  of  cassia  are 
employed  by  many  as  antiseptics  in  dental  practice.     In  the 


136  QENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

treatment  of  putrescent  root-canals  the  writer  has  secured 
very  satisfactory  results  from  both  these  drugs.  Applied  to 
exposed  and  inflamed  dental  pulps,  they  will  give  temporary 
relief,  and  have  been  recommended  for  the  treatment  of  pyor- 
rhoea alveolaris,  combined  with  iodoform.  Dr.  Black's  ''  i, 
2,  3  mixture"  is  composed  of  oil  of  cinnamon,  i  part;  car- 
bolic acid  (crystals),  2  parts;  oil  of  gaultheria,  3  parts.  This 
is  employed  in  the  local  treatment  of  pyorrhoea  alveolaris,  and 
for  alveolar  abscesses,  etc. 

ELECTROZONE. 

Derivation. — Electrozone  is  the  product  of  sea-water 
specially  treated  by  electrolysis.  It  has  been  so  named  from 
the  fact  that  it  is  manufactured  with  the  aid  of  the  electric 
current,  and  the  oxidizing  agent  being  ozone.  The  result 
of  electrolysis  thus  performed  is  the  formation  of  new 
compounds,  consisting  of  the  hypochlorites,  hypobromites, 
etc.,  and,  it  is  claimed,  the  substitution  of  free  oxygen  and 
peroxide  of  hydrogen  for  the  air  between  the  molecules  of 
water. 

Properties  and  Actions. — It  is  a  clear,  colorless  liquid, 
having  an  unpleasant,  salty  taste,  and  an  odor  resembling 
chlorine.  It  is  a  non-poisonous  and  efficient  antiseptic,  ger- 
micide, and  disinfectant. 

Therapeutic  Uses. — It  is  much  used  for  diphtheria, 
catarrh,  and  fevers,  and  is  applied  to  burns,  scalds,  and 
wounds  of  any  nature. 

Dental  Uses. — It  is  valuable  to  the  dentist  for  its  anti- 
septic and  gemicidal  qualities,  and  is  very  efficacious  in  the 
treatment  of  acute  pulpitis,  giving  almost  instant  relief. 
The  writer  has  also  found  it  very  valuable  in  the  treatment  of 
root-canals,  as  a  mouth-wash,  and  wherever  a  harmless  germ- 
icide and  deodorizer  is  desirable. 


CATHARTICS.  I37 

CATHARTICS. 

Cathartics,  or  purgatives,  are  agents  which  hasten  the  intes- 
tinal evacuations  ;  they  comprise  such  substances  as  magnesia 
preparations  (Epsom  salt),  senna,  rhubarb,  fruits  of  various 
kinds,  etc. 

MAGNESIA,  MgO. 

Derivation. — Magnesia,  or  magnesium  oxide,  is  obtained 
by  subjecting  magnesium  to  a  red  heat  in  the  open  air,  when 
it  will  burn  with  a  bright  light  and  produce  MgO. 

Properties. — Magnesia  is  a  very  light,  white  powder, 
odorless,  has  an  earthy  taste,  is  freely  soluble  in  water, — more 
so  in  cold  water, — and  neutralizes  acids. 

Actions. — Magnesia  is  an  efficient  aperient  (mild  purga- 
tive), is  antacid, — hence  an  excellent  remedy  for  great  acidity 
of  the  stomach, — and  is  the  antidote  for  poisoning  by  mineral 
acids.  Wherf  it  is  desirable  to  administer  magnesia  in  large 
doses  and  for  a  considerable  length  of  time,  it  may  be  given 
in  connection  with  lemonade,  which  v/ill  render  it  more 
soluble,  avoiding  its  accumulation  in  the  bowels. 

Chief  Preparations :  — 

Sulphates  of  Magnesia,  "  Epsom  salts,"  ''salts."  Dose, 
5J-5J,  in  water,  a  popular  purgative. 

Liq.  Citrate  of  Magnesia  (magnesium  carbonate), 
citric  acid,  potassium  bicarbonate,  and  water.     Dose,  ^iv-vj. 

Dose  of  Magnesia  as  an  aperient,  gr.  x-^j.  As  an 
antacid,  gr.  20  Oj). 

Dental  Uses. — The  form  of  magnesia  usually  employed 

in  dental  practice  is  known  as  magnesium  hydrate,  or  viilk  of 

magnesia,  and   consists    of   precipitated   magnesium  hydrate 

held    in  suspension   in  water,  and  is  employed   for  counter- 

10 


138  DENTAL    PATHOLOGY    AND    DENIAL    MEDICINE. 

acting  the  injurious  action  of  acid  secretions,  especially  in 
cases  of  erosion.  It  is  applied  in  the  same  way  that  lime- 
water  or  precipitated  chalk  is  used  for  the  purpose  of  bring- 
ing about  an  alkaline  condition  of  the  oral  fluids,  by  neutral- 
izing the  excess  of  acids  present.  A  teaspoonful  of  the  pre- 
paration taken  into  the  mouth  and  allowed  to  float  around 
over  the  teeth  coats  them  with  a  slight  alkaline  film,  which 
protects  the  tooth  surface  from  the  acid  action  for  several 
hours. 

MISCELLANEOUS  DRUGS. 

GLYCERIN. 

Derivation. — Glycerin  is  a  production  of  the  saponifica- 
tion of  fixed  oils  and  fats;  it  also  contains  a  small  percentage 
of  water. 

Properties  and  Actions. — It  is  a  colorless,  syrupy 
liquid,  having  a  sweet  taste  but  no  odor;  soluble  in  water  or 
alcohol.     It  is  a  solvent,  preservative,  emollient,  and  nutrient. 

Therapeutic  Uses. — It  is  used  to  dissolve  iodine,  iodide 
of  potassium,  borax,  tannic  acid,  creasote,  carbolic  acid,  etc. 
It  is  much  used  in  poultices  and  for  roughness  of  the  skin, 
as  one  of  the  ingredients  for  dressings  for  wounds  and  ulcers, 
erysipelas,  and  small-pox  (to  prevent  pitting).  Glycerin  is 
used  in  cases  of  earache  and  deafness.  It  should  be  mixed 
with  a  little  water  before  applying  to  abraded  or  cut  surfaces 
to  prevent  smarting. 

Dental  Uses. — Glycerin  is  much  used  in  dental  practice 
as  a  solvent  and  emollient.  It  is  used  in  the  treatment  of 
diseases  of  the  mucous  membrane  of  the  mouth,  such  as 
ulcers,  stomatitis,  alveolar  abscess,  etc.  Combined  with  lime- 
water,  rose-water,  gum  tragacanth,   etc.,  it  forms  ointments 


MISCELLANEOUS    DRUGS.  1 39 

and  emollients.      Combined  with  atropine,  acetate   of  lead, 
morphine,  etc.,  it  is  used  as  an  anodyne  and  emollient. 


COLLODION. 

Derivations. — Collodion  is  a  solution  of  pyroxylin, 
stronger  ether,  and  alcohol,  in  the  proportion  of  4,  70,  and  26 
respectively.  Pyroxylin,  or  common  gun-cotton,  is  a  mixture 
of  nitric  and  sulphuric  acids  added  to  cotton  freed  from  im- 
purities. 

Properties  and  Actions. — Collodion  is  a  colorless,  in- 
flammable liquid,  of  the  consistency  of  syrup,  with  an 
ethereal  odor.  It  is  used  to  protect  abraded  or  cut  surfaces 
from  the  air,  by  means  of  the  film  which  it  forms.  Owing 
to  its  astringent  tendencies  it  draws  together  and  holds  in 
apposition  divided  parts. 

Therapeutic  Uses. — It  is  applied  to  ulcers,  abraded  sur- 
faces, fissures,* and  is  also  used  in  skin  diseases  and  erysipelas. 

Dental  Uses. — Combined  with  carbolic  acid  it  is  applied 
for  odontalgia.  With  iron,  etc.,  it  forms  a  styptic  prepara- 
tion. When  a  number  of  layers  are  applied,  it  will  sometimes 
prevent  an  alveolar  abscess  from  discharging  on  the  face, 
causing  it  to  open  in  the  mouth.  It  is  useful  in  the  dental 
laboratory  for  coating  plaster  models,  protecting  the  sur- 
face. Should  it  become  too  thick,  dilute  with  a  solution  of 
ether  and  alcohol,  3  to  i. 

SANDARACH. 

Derivation. — Sandarach  is  derived  from  an  evergreen 
tree  common  to  Northern  Africa. 

Properties  and  Actions. — Sandarach  gum  is  in  the  form 
of  small,  irregular  drops,  of  a  light  yellow  color,  occasionally 


I40  DENTAL    PATHOLOGY    AND    DENTAL    MEDICINE. 

brown  ;  brittle,  and  slightly  transparent.  It  has  an  agreeable 
odor  and  a  resinous,  acrid  taste.  It  is  inflammable,  and  when 
melted  by  heat  throws  out  a  strong  balsam  odor.  It  dis- 
solves readily  in  alcohol  or  ether. 

Dental  Uses. — The  alcoholic  solution  of  sandarach  is 
much  used  in  dental  practice  as  a  varnish  for  coating  plastic 
fillings,  etc.  ;  and  applied  on  cotton  as  a  temporary  stopping, 
and  for  a  coating  for  cotton  used  for  separating  purposes. 


APPENDIX. 


EMERGENCIES. 


PRELIMINARY  REMARKS. 

Nothing,  of  course,  can  take  the  place  of  the  advice  and 
service  of  an  experienced  physician  in  time  of  emergencies; 
but  the  physician  is  not  always  at  hand,  and  accidents  of 
various  kinds  may  occur  in  the  dental  office,  or  patients  in 
distress  present  themselves  to  the  dental  practitioner  for  im- 
mediate relief;  or  some  one  maybe  burned,  cut,  poisoned, 
or  suff'ocated,  where,  if  we  possess  presence  of  mind  and 
sufficient  knoAvledge,  it  may  be  our  privilege  to  save  an 
endangered  life.  It  is,  therefore,  expedient  that  the  dental 
student  should  have  a  more  thorough  knowledge  of  what  to 
do  in  case  of  such  emergencies  ;  it  is  for  that  purpose  that 
this  chapter  of  practical  suggestions  is  prepared. 

Apoplexy  is  the  rupturing  of  a  blood-vessel  in  the  brain. 
The  symptoms  are  stupor,  heavy  snoring  breathing,  slow  pulse, 
flushed  face,  followed  by  paralysis  usually  of  one  side,  this 
being  marked  by  the  drawing  up  of  one  side  of  the  face. 

Treatme7it. — Loosen  clothing  about  the  neck,  make  cold 
applications  to  the  head,  and  keep  the  patient  in  a  sitting 
posture  until  the  physiician  arrives. 

Burns  or  Scalds. — Not  infrequently  does  some  one's 
clothing  take  fire,  usually  that  of  women,  on  account  of  the 
character  of  their  clothing.  The  first  thing  to  do  in  time  of 
such  an  accident  is  to  have  the  patient  lie  down,  but  if  she 

14T 


142  APPENJJIX. 

loses  her  presence  of  mind  and  will  not  obey  instructions, 
she  must  be  quickly  placed  upon  the  floor  or  ground  and 
then  covered  or  enveloped  at  once  with  the  first  article  you 
seize  that  will  exclude  the  air  and  smother  the  flame — a 
breadth  of  carpet,  rug,  blanket,  or  coat  will  serve  the  purpose. 

After  the  fire  is  extmguished,  or  after  an  extensive  scald,  if 
there  is  much  of  a  burn  or  blister,  the  clothing,  as  much  as 
need  be  removed,  should  be  carefully  clipped  away,  so  as  not 
to  break  the  blisters  that  may  have  formed.  These  may  be 
punctured  at  one  edge  and  their  contents  discharged,  when 
the  outer  skin  will  fall  back  in  place.  Then  a  dressing  of 
pure  sweet-oil  or  castor  oil  should  be  carefully  applied  on 
strips  of  soft  linen.  When  the  skin  is  destroyed,  the  air  may 
be  excluded  by  applying  at  once  any  of  the  following: 
sweet  oil,  linseed  oil,  collodion,  vaseline,  etc.  Dr.  Charles 
Dulles,  in  his  manual  on  accidents  and  emergencies,  says :  "In 
case  of  a  person  severely  and  extensively  burned,  the  entire 
body  may  be  immersed  in  a  bath,  which  shall  be  kept,  as  long 
as  necessary,  at  a  temperature  of  ioo°.  Where  the  shock  of 
a  burn  is  great  some  stimulant  should  be  given,  and  laudanum, 
in  twenty-drop  doses  to  an  adult,  and  half  as  much  to  a  child, 
to  allay  the  suffering." 

For  Slight  Burns  or  Scalds,  an  excellent  dressing  is  to 
quickly  sprinkle  the  parts  with  bicarbonate  of  soda  and  cover 
same  with  wet  cloth,  or  they  may  be  painted  with  white  lead, 
or  covered  with  the  white  of  an  tgg  or  carron  oil  (equal  parts 
of  linseed  oil  and  lime-water) — in  fact,  anything  that  will  ex- 
clude the  air  and  prevent  friction,  and  will  not  prevent  after- 
examination,  may  be  used.  Aristol  ointment  (aristol  in  cold 
cream  or  vaseline)  is  also  being  used  with  good  results,  while 
for  small  burns  on  the  hand,  arm,  leg,  etc.,  immerse  in- 
stantly in  cold  water,  and  let  it  remain  for  some  length  of 
time. 


APPENDIX.  143 

Burns  with  Acids  or  Caustic  Alkalies,  such  as 
soap  lye,  should  be  deluged  with  water,  and  followed  by  an 
application  of  bicarbonate  of  soda  for  the  former  and  vinegar 
for  the  latter,  to  be  followed  by  an  application  of  oil. 

Catalepsy  in  appearance  somewhat  resembles  death.  The 
patient  becomes  unconscious,  the  muscles  rigid,  and  the  skin 
pallid.  In  itself  it  is  by  no  means  dangerous,  and  it  affords 
time  enough  to  summon  a  doctor,  which  is  the  only  sensible 
thing  to  do  under  these  circumstances. 

Choking  is  usually  caused  by  the  lodgment  of  some  foreign 
substance  in  the  trachea  or  oesophagus.  When  the  body  is 
lodged  in  the  trachea,  there  is  great  irritation  and  coughing, 
though  it  does  not  materially  interfere  with  deglutition. 
While,  on  the  other  hand,  when  the  oesophagus  is  closed,  it 
is  usually  impossible  to  swallow,  and  there  is  little  or  no 
coughing. 

Treatmejit. — Hold  the  head  low  and  slap  the  back  quite 
forcibly.  Blow  into  the  ear,  which  will  excite  a  reflex  action 
that  will  aid  the  patient  in  expelling  the  foreign  body.  The 
removal  of  pins,  needles,  splinters,  fish  bones,  etc.,  from  the 
throat  is  usually  an  extremely  delicate  operation.  They 
should  be  grasped  with  a  small  pair  of  forceps  or  tweezers,  or 
a  blunt  pair  of  scissors  may  be  used  for  the  same  purpose. 

Convulsions  are  usually  caused  by  some  irritation  of  the 
digestive  apparatus,  or  by  some  interfei'ence  in  the  eruption  of 
the  teeth. 

Treatment. — When  the  physician's  coming  is  delayed,  the 
child  should  be  placed  in  a  hot  bath  ;  the  head  at  the  same 
time  should  be  kept  cool  by  cold  applications.  This  should 
be  continued  for  about  ten  minutes,  when  the  child  should  be 
wrapped  in  warm  blankets  and  put  to  bed.  If  there  should 
be  one  or  inore  teeth  endeavoring  to  erupt  at  this  time,  the  gums 
should  be  freely  lanced. 


144  APPENDIX 

Dislocations  can  be  easily  detected.  There  is  always  de- 
formity, pain,  and  stiffness  of  the  joint  affected. 

Dislocation  of  the  lower  jaw,  with  treatment  for  same,  is 
fully  treated  upon  pages  55  and  56. 

Dislocation  of  the  fingers  can  usually  be  corrected  by 
strong  pulling  and  at  the  same  time  pressing  the  parts  into 
place,  where  they  should  be  retained  for  several  days  by  a 
splint  and  bandage. 

Dislocations  of  other  joints  had  better  be  left  for  the 
surgeon's  hands.  *'  The  risk  of  doing  injury  by  injudicious 
efforts  to  set  a  joint  is  greater  than  that  of  waiting  until  a 
surgeon  can  be  summoned."  The  patient,  however,  should 
be  placed  in  the  most  comfortable  position  and  hot  fomenta- 
tions should  be  applied. 

Drowning. — It  is  important  to  remember  that  tlie  body, 
as  a  whole,  is  a  very  little  lighter  than  water;  therefore,  a 
person  who  is  in  danger  of  drowning  sliould  lie  flat  on  the 
back  and  keep  the  entire  body,  with  the  exception  of  the 
mouth  and  nose,  under  water.  The  arms  should  be  stretched 
at  full  length  above  the  head,  and  the  lungs  should  be  kept 
filled  with  air  as  much  of  the  time  as  possible.  This  would 
very  materially  aid  both  the  one  in  danger  and  the  rescuing 
party. 

Resuscitation. — Avoid  delay.  Do  not  wait  to  carry  the 
patient  to  a  house  or  hospital,  but  treat  him  on  the  spot. 
*'  Remember  that  the  patient  is  suffering  from  two  things, 
want  of  air,  or  oxygen,  and  loss  of  heat  from  the  body."  The 
first  thing  to  do,  then,  is  to  free  the  body  from  any  clothing 
that  may  interfere  with  respiration — that  is,  about  the  neck, 
chest,  and  waist.  If  natural  breathing  has  ceased,  artificial 
respiration  should  be  commenced  as  soon  as  possible.  First, 
hastily  make  a  roll  from  clothing,  blankets,  or  anything  that 
may  be  at  hand,  place  the  patient  over  this,  face  downward, 


APPENDIX. 


145 


ta 


o 


146  APPENDIX. 

allowing  his  forehead  to  rest  upon  one  hand  to  keep  the  mouth 
and  nose  clear  of  the  ground.  Place  the  hands,  well  spread, 
upon  the  pa-tient's  back,  over  the  stomach  and  base  of  thorax. 
Then,  with  a  forward  motion,  throw  all  the  weight  upon  them 
that  the  age  and  sex  of  the  patient  will  justify.  Repeat  this 
three  or  four  times,  which  will  cau^e  the  water  and  mucus  to 
run  out  of  the  mouth,  throat,  and  trachea.  (See  Fig.  22.) 
Wrap  a  handkerchief  around  the  forefinger  and  pass  it  into 
the  mouth  and  remove  any  mucus  that  may  remain.  Turn  the 
patient  on  his  back,  grasp  the  tongue  and  draw  it  forward  and 
down  onto  the  chin  ;  lay  a  strip  of  the  handkerchief  or  other 
material  across  the  tongue  and  pass  the  ends  behind  the  neck 
and  tie,  or  have  some  one  to  hold  the  tongue  to  keep  it  from 
falling  back  and  closing  the  throat.  Then  begin  artificial 
respiration. 

Howard's  Method. — The  patient  is  placed  upon  his 
back,  his  arms  extended  backward  and  outward,  where  they 
should  be  held  by  an  assistant.  A  roll  of  something  (cloth- 
ing, a  folded  blanket,  coat,  or  stick  of  wood,  if  nothing 
better  is  at  hand)  is  then  placed  under  the  false  ribs  so  as  to 
throw  them  prominently  forward.  The  operator  should  then 
kneel  astride  the  patient's  abdomen,  placing  both  hands  so 
that  the  fingers  will  press  into  the  intercostal  spaces  on 
each  side,  and  the  base  of  the  thumb  rest  upon  the  anterior 
margin  of  the  false  ribs.  The  operator  should  then  place  his 
elbows  firmly  against  his  sides,  and  throw  himself  forward, 
bringing  his  weight  to  bear  upon  the  patient's  false  ribs, 
forcing  them  inward  and  upward  toward  the  diaphragm, 
then  suddenly  let  go  and  return  to  the  erect  position. 
Repeat  these  movements  ten  to  twelve  times  a  minute 
until  natural  breathing  begins,  which  may  gradually  take  the 
place  of  the  artificial.      Fig.  23  illustrates  this  method. 

Sylvester's  Method. — After  the  patient  has  been  placed 


APPENDIX. 


147 


o 


[^ 


148  APPENDIX. 

upon  his  back,  with  folded  clothing  under  his  shoulders,  the 
operator  should  kneel  behind  his  head  and  go  through  the 
following  manipulations:  — 

First,  to  induce  inspiration  :  Grasp  both  arms  just  below 
the  elbows  and  swing  them  around  horizontally  until  they 
nearly  meet  above  the  head,  with  the  back  of  the  hands  or 
elbows  touching  the  ground  ;  hold  them  there  for  three  or 
four  seconds.  This  draws  the  ribs  up  so  as  to  expand  the 
chest  and  allows  the  air  to  enter  the  lungs.     (See  Fig.  24.) 

The  second  movement  is  to  induce  expiration.  Bend  the 
arms  at  the  elbows,  and  carry  them  down  so  that  they  rest 
upon  either  side  of  the  chest.  Bring  the  weight  of  your  body 
upon  them,  pressing  forcibly  and  steadily,  which  pressure,  if 
continued  for  a  few  seconds,  will  force  the  air  out  of  the 
lungs.  (See  Fig.  25.)  These  movements  should  be  continued 
alternately  twelve  to  fifteen  times  a  minute. 

lVhe7i  natural  breathing  is  attempted,  it  may  be  stimulated 
by  applying  smelling  salts  or  ammonia  to  the  nose,  or  by 
slapping  the  chest.  When  the  patient  is  able  to  swallow, 
some  stimulant  should  be  given  every  few  minutes  until  the 
danger-point  is  passed — such  as  a  teaspoonful  of  whisky  or 
brandy,  or  double  the  quantity  of  hot  water.  After  the 
patient  is  resuscitated  he  should  be  wrapped  in  warm  blankets 
and  carefully  carried,  with  the  head  low,  to  a  warm  bed. 

Epileptic  Fits  are  characterized  by  sudden  loss  of  con- 
sciousness and  power  of  coordination  of  motion  ;  there  is  a 
rigidity  of  motion  which  is  followed  by  violent  convulsions 
of  short  duration,  usually  accompanied  by  more  or  less 
foaming  at  the  mouth.  There  is  also  a  peculiar  cry  that 
accompanies  these  attacks,  caused  by  laryngeal  spasms. 

Treatme?it. — There  should  be  no  struggling  with  the  patient, 
but  an  effort  should  be  made  to  regulate  the  movements  so 


APPENDIX. 


149 


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APPENDIX.  151 

that  the  patient  will  not  do  himself  any  harm.  A  folded 
napkin  or  towel  or  a  soft  piece  of  wood  should  be  placed  be- 
tween the  teeth  to  prevent  biting  the  tongue.  As  soon  as  the 
convulsions  are  passed,  the  patient  should  be  allowed  to  rest 
quietly  in  bed  for  some  time.  Dr.  Dulles  says  :  —  "It  would 
be  a  good  plan  if  every  one  who  is  subject  to  epileptic  attacks 
had  his  or  her  name  and  address  placed  inside  the  coat  or  in 
some  place  where  it  could  be  seen  at  once  when  the  clothing 
is  loosened'  to  give  relief,  as  is  almost  invariably  done  when 
such  attacks  occur.  Epileptics  should  not,  except  where  it  is 
absolutely  unavoidable,  go  about  alone,  or  go  into  crowded 
places.  They  have  no  right,  on  their  own  account  and  for 
the  sake  of  others,  to  incur  risks  involved  in  such  conduct, 
except  under  the  stress  of  necessity." 

Exhaustion,  Heat. — This  is  not  a  serious  illness.  It  is 
usually  caused  by  physical  overwork  in  hot  and  badly  venti- 
lated rooms  or  in  the  heat  of  summer, — the  latter  is  apt  to  be 
confounded  with  heat  or  sunstroke.  In  heat  exhaustion, 
however,  there  is  a  cool,  moist  skin,  while  in  sunstroke  the 
bodily  temperature  is  raised  and  the  skin  is  quite  dry. 

Treatment  of  heat  stroke  is  very  simple.  The  patient  should 
have  complete  rest,  plenty  of  fresh  air,  and  a  mild  stimulant 
— hot  soup^  milk,  tea,  or  coffee,  or  a  small  dose  (one  or  two 
teaspoonfuls)  of  wine  or  brandy. 

Fainting  is  caused  by  the  cutting  off  of  the  supply  of 
blood  to  the  brain,  which  is  due  to  a  temporary  weakening  of 
the  heart's  action. 

Treatment. — If,  for  any  reason,  the  patient  does  not  fall  to 
the  floor  or  couch  so  as  to  bring  the  head  low,  the  body 
should  be  placed  in  such  a  position.  This  is  to  aid  the 
heart  in  sending  the  blood  to  the  brain,  and  if  the  head  is 
placed  a  little  lower  than  the  body,  the  force  of  gravity  will 
aid  very  much  in  sending  the  blood  where  it  is  needed.     At 


152  APPENDIX. 

the  same  time  the  clothing  should  be  loosened  and  plenty  of 
fresh  air  admitted.  Cold  water  may  be  sprinkled  upon  the 
face,  and  ammonia  or  smelling  salts  applied  to  the  nose  tend 
to  excite  the  nerves  of  sensation  and  rouse  the  heart  to 
renewed  activity. 

Fractures. — Fractured  bones  may  be  recognized  by  the 
deformity  and  abnormal  mobility  of  the  parts  affected.  It  is 
also  usually  accompanied  by  crepitus, — a  clicking  or  grating 
sensation  at  the  point  of  fracture. 

The  Treatment  of  fractures  should  not  be  attempted  by  any 
one  who  has  not  surgical  training,  and  as  there  is  no  great 
haste  necessary,  an  effort  should  be  made  to  simply  place  the 
patient  in  as  comfortable  a  position  as  possible  until  the  phy- 
sician arrives.  The  following  notes  and  illustration  (Fig.  26) 
are  taken,  with  permission  of  the  author,  from  Dr.  G.  R. 
Butler's  "Emergency  Notes"  :  — 

^''  If  patient  must  be  7noved,  or  travel  some  distance^  ^PP'y 
temporary  splints  or  dressings  to  prevent  further  injury  from 
movement. 

"  In  city  or  country  one  of  the  following  list  of  materials 
may  usually  be  found,  and,  by  the  aid  of  a  little  ingenuity, 
utilized  for  temporary  dressings  :  — 

*'  For  Splints. — Cigar  boxes,  pasteboard  (boxes,  book- 
covers),  folded  newspapers,  shingles,  barrel- staves,  umbrellas, 
walking-sticks,  rulers,  paper-cutters,  branches,  twigs,  straw, 
fence-palings,  spoons,  tongs. 

^''  For  Padding. — Cotton,  flannel,  towels,  flax,  jute,  oakum, 
hay,  moss,  piece  of  blanket,  coat-sleeves  or  stockings  stuffed 
with  grass,  hay,  straw,  or  leaves. 

^^  For  Bandages. — Handkerchiefs,  stockings,  garters,  sus- 
penders, sheets,  blankets,  and  patient's  clothing  torn  into 
strips. 

"  The  temporary  treatment  of  the  following  special  fractures 


APPENDIX. 


153 


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154  APPENDIX. 

should  be  studied  and  personally  practised.     Some  of  these 
improvised  splints  and  their  application  are  shown  in  Fig.  26. 

^^  Jaw-bone. — Four-tailed  bandage.      (See  page  47.) 

*'  Collar-bone. — Broad  bandage  around  chest  and  arm  of 
injured  side.     Broad  arra-sling. 

"  Upper  Arm-bone. — Two  splints.      Narrow  armsling. 

*'  Forearm  and  Wrist  bone. — One  splint  reaching  to  base  of 
fingers.     Broad  armsling. 

^^  Ribs. — Broad  bandage  around  chest,  applied  during  ex- 
piration— /.  e.,  chest  emptied  of  air. 

"  Thigh-bone. — Preferably  a  long  posterior  (back)  splint, 
reaching  from  waist  to  heel.  If  this  can  not  be  secured, 
simply  tie  limbs  together. 

^^  Leg  and  Ankle-bones. — Internal  (inside)  splint,  or  tie 
limbs  together."     (See  Fig.  26  for  illustrations.) 

Freezing  of  the  ears,  nose,  hands,  or  feet  sometimes  takes 
place  in  such  a  deceptive  manner  that  much  damage  is  done 
before  it  is  recognized,  for  one  may  go  sometimes  with  a  part 
of  the  body  frozen  and  not  be  aware  of  it,  on  account  of  the 
absence  of  sensation  in  the  part,  which  is  due  to  the  freezing 
of  the  nerves. 

TreatmeJit. — Warmth  and  circulation  is  the  first  demand, 
and  this  should  be  restored  gradually  until  normal  (98°  Fahren- 
heit). This  is  best  accomplished  by  applying  snow  or  cold 
water  to  the  part,  to  which  gradually  add  warm  water; 
gentle  friction,  too,  is  found  beneficial.  The  after  effects,  if 
serious,  should  have  similar  treatment  to  that  of  a  burn.  If 
the  whole  body  or  a  large  part  of  it  is  frozen,  after  the  normal 
temperature  is  restored  the  patient  should  be  wrapped  in  warm 
blankets  and  given  some  internal  stimulant,  as  tea  or  coffee, 
until  the  physician  arrives. 

Hemorrhage.  —  There  is  no  accident  where  a  little 
accurate  knowledge  and  a  level  head  is  of  more  value  than  in 


APPENDIX.  155 

case  of  hemorrhage,  whether  it  be  from  some  external  wound 
or  from  the  rupture  of  a  blood-vessel  internally.  Hemorrhage 
may  occur  from  three  sources,  the  arteries,  veins,  or  capil- 
laries ;  and  its  source  can  usually  be  determined  by  the  color 
and  manner  in  which  the  blood  flows. 

Arterial:  Hemorrliage  from  an  artery  is  very  dangerous, 
and  life  is  often  quickly  lost ;  here  it  is  that  knowledge, 
judgment,  and  coolness  is  called  for.  The  blood  from  an 
artery  is  bright  red  and  flows  in  jets,  each  jet  or  spurt  cor- 
responding to  the  beating  of  the  heart. 

Venous  or  Capillary  Hemorrhage  is  marked  by  the  slow 
steady  flow  of  blood,  it  being  darker  than  the  arterial  blood. 

Treatment. — The  first  thing  to  do  in  all  cases  of  hemor- 
rhage is  to  elevate  the  bleeding  part,  whenever  possible,  above 
the  level  of  the  heart.  If  in  the  hand  or  arm,  raise  above  the 
head.  In  this  position  the  blood  has  to  travel  up  hill,  and 
therefore  reaches  the  wound  with  less  force,  which  means 
slower  escape  of  blood,  and  a  greater  likelihood  of  forming  a 
clot  at  the  mouth  of  the  wound.  Cold  water  or  ice  applied 
to  the  parts  assists,  especially  in  wounds  of  small  arteries,  by 
contracting  the  vessels.  Styptics  should  be  applied  to  con- 
tract the  bleeding  surface*' and  to  aid  in  forming  a  clot. 
Probably  the  best  remedies  for  this  purpose  are  tannic  acid, 
subsulphate  of  iion,  or  a  mixture  of  vinegar  and  water,  about 
one  part  of  the  former  to  four  of  the  latter.  Pressure  on  the 
artery  at  the  wounded  point  or  above  the  wound  is  a  very 
simple  expedient  and  will,  in  nearly  all  cases,  prove  of  very 
great  value  in  controlling  the  flow  of  blood  until  more 
permanent  means  can  be  employed.     Several  methods  follow: 

Pressure  v/ith  the  fingers  is  made  by  placing  one  finger  just 
above  and  one  below  the  wound,  and  crowding  the  edges 
together  firmly. 

*  See  page  119. 


156  APPENDIX. 

Pressure  by  compress  and  bandage  consists  of  making  a 
compress  of  some  soft  material,  such  as  muslin,  linen,  cheese 
cloth,  etc.,  folded  into  suitable  shape  and  bound  securely 
upon  the  wound  with  a  bandage. 

Pressure  above  the  wound  may  be  made  by  tlie  finger,  or 
when  the  wound  is  in  a  limb  a  tourniquet  may  be  employed, 
which  is  readily  made  by  tying  a  handkerchief  around  the 
limb  loosely,  with  secure  knots,  then  pass  a  pencil  or  knife 
through  the  handkerchief  and  twist  in  such  a  manner  as  to 
tighten  it  sufficiently  to  stop  the  bleeding.  This  may  be 
continued  until  the  surgeon  has  ligated  the  artery,  which,  if 
necessary,  should  be  as  soon  as  possible. 

Hemorrhage  from  the  Nose  is  not  infrequent  and  is 
usually  not  dangerous.  It  is  generally  due  to  the  rupture  of 
some  of  the  capillaries  of  the  lining  membrane  of  the  nose. 
But  there  are  times  when  the  bleeding  is  due  to  the  rupture  of 
a  small  artery,  possibly  from  ulceration,  when  it  is  so  profuse 
as  to  threaten  life.  In  some  cases,  which  are  very  rare, 
medical  aid  should  be  summoned  at  once. 

Treatment. — Have  the  patient  to  sit  upright,  and  to  hold 
the  hands  above  the  head,  at  least  the  one  on  the  bleeding 
side.  Take  a  towel  and  wring  out  of  ice  water  or  place  in  it 
finely  cracked  ice,  and  wrap  it  around  the  neck.  If  bleeding 
continues,  have  patient  snuff  up  from  the  hand  or  inject  into 
the  nostrils,  with  a  small  syringe,  ice  water  and  alum,  a  tea- 
spoonful  of  alum  to  a  half-glass  of  water.  Vinegar,  too,  used 
in  the  same  manner,  will  usually  stop  the  flow  of  blood.  But 
if  these  means  should  fail.  Dr.  Butler's  plan  will  be  found  very 
good.  He  says:  ''Take  a  piece  of  cotton  wool  as  large  as 
the  first  joint  of  the  thumb,  tie  a  thread  around  its  middle, 
soak  it  in  alum  water,  or,  if  that  is  not  at  hand,  oil  it  with 
sweet  oil  or  vaseline  and  plug  the  nostril.  This  is  best  done 
by  pushing  the  cotton  with  a  screwing  or  twisting  motion 


APPENDIX.  157 

until  firmly  lodged.     The  thread  serves  to  draw  it  out  when 
required." 

Hemorrhage  from  the  Gums  can  usually  be  controlled  by 
syringing  the  mouth  or  sockets  (if  teeth  have  been  extracted) 
with  warm  water  to  remove  clots,  then  rinse  the  mouth  freely 
with  ice  water  and  alum.  If  this  should  fail,  some  good 
styptic  should  be  applied.  (See  page  6;^,  "  Hemorrhage  after 
Extraction.") 

Hemorrhage  from  the  Stomach  may  be  caused  by  in- 
flammation, cancers,  corrosive  poisons,  etc.,  or  may  occur 
without  any  apparent  cause.  It  is,  however,  not  a  very  fre- 
quent occurrence.  The  blood  in  such  cases,  when  vomited, 
is  usually  of  a  dark  brown  color,  resembling  coffee  grounds, 
unless  it  has  very  recently  and  suddenly  escaped  into  the 
stomach,  when  it  is  of  a  bright  red  color.  Bleeding  from  the 
stomach  should  not  be  mistaken  for  bleeding  from  the  lungs. 
It  is  therefore  important  to  remember  these  facts  :  that  blood 
from  the  stomach  is  usually  of  a  dark  brown  color  and  is 
vomited  and  not  frothy,  while  blood  from  the  lungs  is  of  a 
bright  7'ed  color  and  is  frothy,  also  that  it  is  coughed  up,  not 
vo77iited. 

Treatment. — Rest  in  bed  should  be  insisted  upon.  Keep 
the  patitnt  calm,  as  excitement  increases  the  heart's  action 
and  the  amount  of  blood  ;  for  the  same  reason  stimulants 
should  not  be  administered.  The  patient  should  be  given 
small  pieces  of  ice  to  swallow,  and  teaspoonful  doses  of 
vinegar  may  be  given  every  ten  minutes.  Also  ice-cold 
cloths  may  be  placed  over  the  stomach. 

Hemorrhage  from  the  Lungs  is  usually  caused  by  con- 
sumption and  is  rarely  if  ever  fatal,  except  sometimes  in  the 
last  stages  of  the  disease.  It  is,  therefore,  not  necessary  to 
apprehend  immediate  death,  as  is  so  often  done. 

Treatment. — The  best  treatment  to  pursue  until  a  physi- 


158  APPENDIX. 

cian  arrives  is  to  place  the  patient  in  a  reclining  position,  but 
not  with  the  head  low,  give  small  lumps  of  ice  to  be  swal- 
lowed, and  let  him  eat  a  teaspoonful  of  salt  with  the  same 
quantity  of  vinegar.  Salt  absorbs  water  from  the  blood,  and 
thus  tends  to  relieve  hemorrhage  by  thickening  the  blood. 
Also,  if  patient  is  not  too  weak,  cloths  wrung  out  of  ice 
water  may  be  applied  to  the  chest  and  neck. 

Intoxication  is  usually  caused  by  an  excessive  use  of 
alcoholic  beverages.  It  sometimes  resembles  apoplexy,  and 
great  care  should  be  taken  in  determining  the  disease,  as  this 
mistake  has  been  made  with  very  embarrassing  results.  It 
should  be  remembered  that  in  drunkenness  there  is  a  helpless- 
ness on  both  sides  alike,  but  no  paralysis ;  that  there  is  usually 
some  sensation  displayed  by  touching  the  eyeball,  and  that 
the  patient  can  be  aroused  from  the  stupor;  also,  that  the 
odor  of  liquor  can  be  detected  upon  the  breath,  though  this 
might  be  the  case  in  apoplexy. 

Treatment. — A  teaspoonful  of  aromatic  spirits  of  ammonia 
in  a  half  or  two-thirds  of  a  glass  of  water  is  a  useful  corrective 
and  stimulant.  If  this  is  not  at  hand,  a  large  draught  of 
vinegar  often  does  much  toward  sobering  an  intoxicated 
person.  In  an  extreme  case,  where  respiration  has  ceased,  or 
where  there  is  evidence  of  collapse,  artificial  respiration 
should  be  resorted  to,  heat  should  be  applied  to  the  body,  and 
copious  draughts  of  hot  coffee  should  be  administered. 

Nausea,  if  caused  by  slight  indigestion,  can  usually  be 
corrected  by  taking  a  teaspoonful  of  baking  soda  and  the 
juice  of  one  lemon  in  a  half  of  a  glass  of  water;  stir  and 
drink  while  foaming.  Or  take  a  teaspoonful  of  aromatic 
spirits  of  ammonia  in  a  third  of  a  glass  of  water.  If  the 
nausea  is  due  to  something  objectionable  to  the  stomach,  the 
soda  and  water  will  usually  give  relief  by  causing  vomiting. 

Poisons. — The  old  maxim,  "an   ounce  of  prevention   is 


Al'PENDlX.  159 

better  than  a  pound  of  cure,"  is  surely  applicable  to  the  sub- 
ject of  poisons.  In  the  first  place,  all  dangerous  articles 
should  be  kept  out  of  the  way  of  children  ;  then,  all  bottles, 
etc.,  containing  anything  of  a  toxic  nature  should  be  dis- 
tinctly marked  "  poison."  A  very  good  plan  is  to  have  such 
bottles  marked  by  a  ball  and  chain,  which  may  be  procured 
at  the  drug  store  ;  this  will  give  warning  in  the  dark  as  well 
as  in  the  light.  When  it  is  discovered  that  a  poison  has  been 
swallowed,  some  one  should  be  dispatched  for  a  physician  at 
once  ;  meanwhile,  treatment  must  be  directed  toward  getting 
rid  of  the  poison  before  it  takes  effect. 

J^i'rs^  administer  a  pi'ompt  emetic.  Some  poisons,  by  their 
irritating  effect,  naturally  produce  vomiting,  so  that  with  a 
little  encouragement  the  stomach  will  be  thoroughly  evacu- 
ated. Where  this  is  not  the  case,  the  emetic  will  provoke  expul- 
sion of  the  matter.  A  very  good  emetic  for  such  an  emergency 
is  lukewarm  water  in  quantity,  or  a  tablespoon ful  of  mustard  or 
salt  to  a  pint  of  warm  water.  As  this  is  no  occasion  for  fas- 
tidiousness, any  water  that  is  at  hand  may  be  used  ;  if  soapy, 
and  the  hands  have  been  washed  in  it,  use  it,  as  by  its  very 
repulsiveness  it  may  act  more  quickly  than  anything  else  ; 
the  patient  should  be  urged  to  drink  freely  until  he  can  con- 
tain no  more,  and  be  made  to  vomit  over  and  over  again. 

This  sometimes  leaves  the  patient  much  depressed  in  body 
and  mind,  showing  signs  of  collapse.  In  such  a  case,  some 
mild  stimulant  may  be  given  ;  hot  tea  is  probably  one  of  the 
best,  as  it  is  also  a  chemical  antidote  to  many  jDoisons. 
Strong,  hot  coffee  is  also  good.  To  either  of  these  a  tea- 
spoonful  of  brandy  may  be  added.  The  patient  will,  of 
course,  be  in  bed,  and  it  should  not  be  forgotten  that  warm 
coverings  are  indispensable.  Hot  bricks  and  hot-water  bags, 
or  bottles,  may  be  brought  into  requisition.  Again,  where  it 
is  known  that  poison  has  been  taken,  and   especially  if  it  is 


i6o 


APPENDIX. 


one  of  the  more  active  and  corrosive,  an  antidote  to  counter- 
act the  action  of  the  poison  should  be  administered  before  or 
after  the  emetic.  The  following  list  of  the  more  common 
poisons,  with  their  antidotes,  etc.,  will  be  useful  for  ready 
reference. 


SPECIAL  POISONS   AND   READY  ANTIDOTES. 

Poison.  Treatment. 

f  Give  an  alkali,  such  as  powdered  chalk,  plas- 

...       o   1   u     •      TVT-.   •      A            I  ter,    lime-water,  as   much   as  patient   can 

Acids-Su  phunc.  Nunc,  Ace-     J  ^^vallow  ;  or  lime  scraped  from  the  plaster 

tie.  Oxalic,  Munatic,  or   Hy-     ^  ^^  whitelwashed  wall,  stirred  in  a   cup   of 

arocnionc j  water.   A  tablespoonful  of  strong  soapsuds, 

t  etc. 

Alkalies — Potash,     Lye,     Soft      ("  Give  an  acid — vinegar, lemon-juice.sour  cider, 

Soap,   Strong    Ammonia    or     <  etc.  Acids  and  alkalies  neutralize  each  oth- 

Hartshorn, (  er — that  is, combine  to  form  harmless  sa/ts. 

{  Milk   and  raw  eggs,  or   flour  and  water,  or 

.           .                                                  J  lime-water  and  oil,  and   after  patient  has 

Arsenic, -j  vomited  freely,  follow  with  a  dose  of  castor 

L  oil. 

f  There    is    no    chemical     antidote,   but    the 

I  stomach  should  be  protected  and  vomiting 

Carbolic  Acid, \  encouraged  by  giving  mucilaginous  drinks, 

I  flour  and  water,  and  oil   freely — olive,  lin- 

L  seed,  or  castor. 

Chloral, Treatment  same  as  opium. 

[  Loosen  clothing  ;  sprinkle  cold  water  on  the 

Chloroform,  Ether,  etc.,  .   .    .      ■<  face;  suspend  the  patient  by  the   legs;  ar- 

(  tificial  respiration,  as  for  drowning. 

Iodine, Starch  and  water  ;  boiled  or  baked  potatoes. 

Lead-Sugar  of  Lead,    ....       {  ^^^^^^ ^f^^;    ^^'^'    vomiting    freely,   give 

Mercury-Bichloride  of    Mer-     ]  p^y^^^^^    uncooked   white   of   eggs,   wheat 

cury    or       Corrosive    Subli-     ^  ^^^     ^j,^    ^^^ 

mate, C 

f  Induce  vomiting  first.     There  is  no   chemi- 
cal antidote,  but  strong  coffee,  pain,  ynotiott, 

-.    .           HT       1  •       T        1  counteract  its   effects.     In   extreme   cases, 

Opium-Morph.ne, Laudanum,     ^  j,^  addition  to  above  treatment,  cold  water 

i-aiegoric, should   bedashed  on   the   face  and  chest, 

I  and  artificial   respiration  and  the  battery 

[  resorted  to. 

r  Provoke  vomiting.  Teaspoonful  doses  of  tur- 

Phosphorus, <  pentine,  mixed  with  magnesia  ;  but  no  oil, 

(.  it  favors  the  action  of  phosphorus. 

PriiQQJr  Arifl                                      /  I^duce  voiiiiting  first,  and   give  teaspoonful 

Frussic  Acid, I  ^j-  j^nimonia  in  water. 

Silver— Nitrate  of  Silver,  "  Lu-      f  Large  teaspoonful  of  salt  in  a  glass  of  water  ; 

nar  Caustic," (  vomiting. 

c^_   rhn'np                                         I  Induce  Vomiting  first ;  give  a  purgative  ;   se- 

atrycnnine, |  cure  absolute  quiet  in  a  dark  room. 


APPENDIX.  I  6  I 

There  are  other  poisons,  such  as  Alcohol,  Aconite,  Bella- 
donna, etc.,  which  need  not  be  classified  here,  as  vomiting 
thoroughly,  followed  by  a  mild  stimulant  and  rest,  is  all  that 
is  needed. 

Poisonous  Bites. — By  this  we  mean  bites  of  rabid  or 
venomous  animals  and  the  stings  of  insects. 

Snake  Bites. — Tie  a  cord,  or  a  handkerchief  twisted  into 
a  cord,  tightly  around  the  part  just  above  the  wound.  Enlarge 
the  wound  by  making  a  cross  cut  through  the  centre  of  the 
bite  with  a  pen-knife.  This  will  encourage  bleeding,  and 
will  expose  the  wound  more  thoroughly  for  the  later  steps  in 
treatment,  which  are  as  follows :  Draw  the  poison  from  the 
wound  by  means  of  suction  with  the  mouth,  unless  the  mouth 
be  sore,  or  by  taking  a  wide-mouthed  bottle,  and  after  satu- 
rating a  piece  of  cotton  or  paper  with  alcohol  or  benzine,  set 
it  on  fire  and  dip  it  into  the  bottle.  As  soon  as  the  flames 
begin  to  die  out,  quickly  invert  the  bottle  over  the  wound 
and  press  tightly  against  the  skin  to  prevent  the  admission  of 
air.  This  will  extract  the  venom  and  blood  from  the  exposed 
vessels.  Then  heat  a  knitting-needle,  a  piece  of  wire,  or 
small  blade  of  a  knife  to  a  white  heat,  and  thrust  it  into  the 
wound.  At  the  same  time  large  doses  of  whisky  or  brandy 
should  be^iven  and  the  patient  kept  under  the  influence  of 
the  stimulant  until  medical  aid  can  be  secured.  Some,  how- 
ever, prefer  to  use  aromatic  spirits  of  ammonia  instead  of 
whisky,  one  drachm  to  a  wineglassful  of  water. 

Mad  Dog  Bites. — There  are  some  physicians  who  claim 
that  there  is  no  such  disease  as  hydrophobia  ;  one  author 
puts  it  in  this  way :  *'  So-called  hydrophobia  exists  exactly  in 
proportion  to  the  common  belief  in  it,"  that  is  to  say,  the 
trouble  is  altogether  mental.  There  is  no  doubt  but  that  a 
great  many  deaths  have  been  caused  by  fright  and  anxiety, 
but  that  all  cases  are  spurious  we  are  not  prepared  to  believe, 


1 62  c.  APPENDIX. 

and  think  that  prompt  and  heroic  treatment  should  always  be 
given. 

As  dogs  are,  with  many  persons,  daily  companions,  it  is  im- 
portant to  know  the  various  symptoms  of  madness.  The  fol- 
lowing is  a  resume  of  the  instructions  issued  by  the  Council 
of  Hygiene,  of  Bordeaux. 

Signs  of  Madness  in  Dogs. — ''  i.  A  short  time  after  the 
disease  has  been  contracted,  the  dog  becomes  agitated  and 
restless,  and  turns  continually  in  his  kennel.  If  unchained, 
he  roams  about  aimlessly  ;  he  seems  to  be  seeking  something  ; 
then  stands  motionless,  as  if  waiting  ;  he  starts,  snaps  at  the 
air,  as  if  catching  a  fly,  and  dashes  himself,  barking  and  howl- 
ing, against  the  wall.  The  voice  of  his  master  recalls  him 
and  he  obeys,  but  slowly,  with  hesitation  and  seeming  regret. 

*'  2.  He  does  not  try  to  bite,  is  gentle,  even  affectionate, 
and  eats  and  drinks  ;  but  gnaws  his  litter,  the  ends  of  the 
curtains,  the  padding  of  cushions,  bed-coverlids,  carpets,  and 
anything  which  happens  to  be  in  his  reach. 

**  3.  From  the  movement  of  his  paws  along  the  sides  of  his 
open  mouth,  one  might  suppose  him  trying  to  free  his  throat 
of  a  bone. 

'*  4.  His  voice  is  changed  so  markedly  that  it  is  impossible 
to  overlook  it. 

*'  5.  He  becomes  surly,  and  begins  to  fight  with  other 
dogs." 

The  symptoms,  however,  vary  in  different  cases,  and  a 
change  in  the  habits  or  manner  of  a  pet  dog  should  always 
be  looked  on  with  suspicion,  and  the  animal  should  be  chained 
for  a  while. 

The  probability  of  hydrophobia  being  communicated  to 
persons  bitten  by  a  mad  dog  varies  with  the  location  of  the 
bite.  If  it  be  in  a  part  unprotected  by  clothing,  inoculation 
is  almost  certain  ;  in  other  parts,  the  chances  depend  on   the 


APPENDIX.  163 

thickness  of  the  clothing,  which  wipes  the  virus  from  the 
teeth. 

Treatme?if. — The  treatment  in  case  of  mad  dog  bite  must 
be  altogether  preventive,  as  after  the  specific  symptoms  mani- 
fest themselves  the  only  thing  to  do  is  to  keep  the  patient 
quiet  by  the  administration  of  hypnotics,  until  death  ensues. 
But  this,  of  course,  belongs  to  the  physician.  When  one  is 
bitten  by  a  rabid  dog,  the  same  course  should  be  pursued  as 
directed  forsnake  bite,  excepting  the  stimulants.  Then  start 
at  once  for  a  hospital,  where  the  patient  can  receive  Pasteur's 
treatment  by  inoculation. 

Bites  and  Stings  of  Insects. — Despite  the  current  be- 
lief that  the  bite  of  the  tarantula,  centipede,  and  other 
insects  are  dangerous  to  life,  experience  proves  that  they  are 
in  nearly  all  cases  comparatively  harmless,  causing  only  tem- 
porary pain  and  annoyance. 

Treatment. — They  may  be  treated  with  cold,  wet  applica- 
tions ;  if  nothfng  better  is  at  hand,  wet  earth  is  good.  The 
application  of  a  few  drops  of  hartshorn  at  the  point  where 
the  sting  entered  will  also  give  relief.  It  sometimes  happens 
that  a  wasp  or  bee  is  swallowed  in  taking  a  drink  of  water 
hurriedly  or  in  the  dark.  In  such  cases  the  fauces  swell 
rapidly  from  the  moment  the  sting  enters  the  throat,  which 
places  the  patient  in  danger  of  suffocation.  This  should  be 
treated  by  the  free  use  of  a  gargle  of  hot  water  and  salt, 
pending  the  physician's  arrival. 

Sea-Sickness. — Sickness  occasioned  by  the  motion  of  a 
vessel  at  sea  is  often  most  distressing.  The  most  efficient 
preventive  or  treatment  is  to  take  a  seat  near  the  centre  of  the 
vessel  (if  inclined  to  keep  up)  and,,  as  the  ship  descends,  take 
a  full  breath  ;  wear  a  wide  firm  belt  around  the  stomach,  eat 
lightly,  plainly,  and  often  ;   if  the  stomach  is  much  disturbed, 


164  APPENDIX. 

take  the  juice  of  one  lemon  in  half  a  glass  of  water,  with  one 
teaspoon ful  of  baking  soda  ;  stir  and  drink  while  foaming. 

Sprains. — A  sprain  is  a  sudden  overstretching  and  tearing 
of  the  ligaments  which  enter  into  the  formation  of  a  joint,  as 
well  as  the  tendons  and  muscles  about  the  joint. 

TreaU7ie?it. — The  joint  should  be  soaked  in  water  as  hot  as 
the  patient  can  bear  for  twenty  minutes  or  more,  then  rub 
gently  with  cosmoline,  and  apply  a  snugly  fitting,  but  not 
tight,  flannel  bandage,  and  give  the  part  as  near  perfect  rest 
as  possible. 

Starvation. — When  a  person  is  found  exhausted  from 
starvation,  lie  should  be  placed  in  a  comfortable  position  and 
given  stimulating,  fluid  food.  Warm  milk,  soup,  and  hot 
coffee  are  among  the  best,  given  a  little  at  a  time,  but  often. 

Strangulation. — In  cases  of  strangulation — that  is,  the 
compression  of  the  windpipe  from  the  outside,  as  in  hanging, 
etc. — the  treatment  to  be  pursued  is  to  remove  the  pressure  at 
once,  and  re-establish  the  respiration,  as  in  drowning. 

SufTocation, — Suffocation  from  foul  air,  noxious  gases, 
etc.,  is  caused  by  a  poisonous  gas  known  as  carbonic  acid. 
When  it  is  desirable  to  enter  a  cellar,  well,  mine,  etc.,  where 
there  is  a  suspicion  of  foul  air,  a  thorough  examination 
should  be  made.  Man  can  not  live  in  an  atmosphere  where  a 
candle  will  not  burn,  animal  life  and  flame  being  both  sup- 
ported by  oxygen.  The  best  test,  therefore,  is  to  lower  an 
unprotected  light  where  foul  air  is  suspected  ;  if  the  flame 
flickers  and  goes  out,  by  no  means  enter. 

Carbonic  acid  gas,  being  heavier  than  air,  can  readily  be 
removed  by  the  use  of  a  pump,  but  if  this  is  not  at  hand, 
quick  lime  (lime  freshly  burned),  scattered  about  in  large 
quantities,  will  accomplish  the  purpose. 

Treatment. — In' case  of  asphyxiation  from  noxious  vapors 
the   patient  should  be  removed  as  soon  as  possible  to   fresh 


APPENDIX.  165 

air,    and    natural    respiration    re-established,  as  directed    for 
drowning. 

SuR  Stroke  does  not  necessarily  arise  from  undue  exposure 
to  the  direct  rays  of  the  sun,  but  may  proceed  from  a  pro- 
longed elevation  of  the  bodily  temperature,  or  from  excessive 
heat  encountered  when  the  vital  forces  are  near  the  point  of 
exhaustion.  It  is  generally  preceded  for  some  time,  usually 
from  one  to  tliree  days,  by  pain  in  the  head,  a  feeling  of 
weakness,  disturbance  of  the  sight,  and  nausea.  This  attack, 
however,  culminates,  usually  after  the  third  day,  in  a  loss  of 
consciousness.  The  skin  is  intensely  hot  and  dry,  the  tem- 
perature rising  as  high  as  112.  In  fevers,  if  the  temperature 
rises  to  105  or  106,  it  is  considered  a  severe  case.  It  is, 
therefore,  apparent  that  the  patient  is  suffering  from  an  excess 
of  heat  in  the  body.  The  thing  to  be  done,  then,  is  to  lower 
the  temperature  as  soon  as  possible.  Every  minute  being  val- 
uable, the  following  treatment  should  be  pursued  :  — 

Treatment. — ^^end  some  one  for  a  physician.  Remove  as 
much  of  the  clothing  as  possible,  and  place  the  patient  in  a 
cool  and  airy  place,  indoors  or  out.  Cold  must  then  be 
applied  to  the  head  and  body,  not  dashed  or  sprinkled,  as  that 
would  only  rause  a  needless  shock ;  but  towels  wrung  out  of 
ice-water,  ^nd  frequently  renewed,  should  be  placed  upon  the 
head,  cracked  ice  placed  in  the  arm-pits,  and  the  body  may 
be  wrapped  in  cold,  wet  blankets.  Continue  this  treatment 
until  the  physician  arrives  or  the  patient  shows  signs  of  con- 
sciousness, then  discontinue,  unless  consciousness  should  again 
be  lost  or  the  surface  of  the  body  becomes  very  hot.  Never 
in  such  cases  administer  a  stijnulant. 

Wounds. — In  surgery,  wounds  are  divided  into  three 
classes,  according  to  their  cause,  namely,  incised,  lacerated^ 
and  contused.  There  is  a  subdivision  of  this  classification,  of 
course,  but  this  is  all  that  is  necessary  for  our  present  purpose. 


l66  APPENDIX. 

Incised  Wounds  are  those  made  by  sharp-cutting  instru- 
ments, making  what  are  called  clean  cuts;  that  is,  there  is 
no  tearing  or  bruising,  but  the  edges  are  clean  cut  and  the 
surface  smooth. 

Treatment. — If  the  wound  is  simple  and  small,  the  only 
treatment  that  is  required  is  to  cleanse  the  edges  and  apply 
adhesive  plaster  and  perhaps  a  bandage.  But  where  the 
wound  is  more  extensive  and  serious,  the  edges  should  be 
brought  firmly  together,  if  possible,  and  held  in  that  position 
by  adhesive  plaster  and  bandages.  But  when  this  will  not 
answer,  hold  the  parts  together  with  the  hands  until  the 
physician  arrives.  Dr.  Dulles  says  :  *'  In  case  an  entire  part 
be  cut  off,  as  an  ear,  or  a  nose,  or  a  toe,  or^a  finger,  it  should 
be  cleansed  with  lukewarm  water  and  put  in  its  place,  leaving 
to  the  surgeon  the  decision  whether  or  not  it  would  be  worth 
while  to  try  to  save  it.  Some  very  remarkable  cases  of  re- 
union of  such  parts  are  on  record,  and  an  attempt  to  save 
them  is  not  to  be  lightly  rejected." 

Lacerated  Wounds  are  made  by  blunt  tearing  instru- 
ments, such  as  dull  tools,  pieces  of  machinery,  nails,  hooks, 
etc.  These  wounds  are  rough  and  ragged  and  usually  bleed 
but  little.  They  should  be  given  surgical  skill,  but  until  this 
can  be  secured  the  torn  parts  should  be  cleansed  by  a  stream 
of  lukewarm  water,  then  brought  as  near  their  natural  posi- 
tion as  possible  and  covered  with  a  cloth  soaked  in  phenol 
sodique,  tincture  of  marigold,  or  laudanum,  and  wrapped 
lightly.  If  no  good  remedy  is  at  hand,  wrap  in  cloth  wrung 
out  of  cold  water.  If  the  patient  seems  much  depressed, 
administer  a  little  brandy  or  wine. 

Contusions  are  what  are  commonly  known  as  bruises  ; 
they  are  usually  caused  by  some  blunt  instrument  or  a  fall  ; 
the  skin  is  not  torn  through,  but  is  often  discolored,  which  is 
due  to  the  rupture  of  the  capillaries,  allowing  the  blood  to 


APPENDIX.  167 

escape  into  the  surrounding  tissues — the  familiar  black  and 
blue  appearance  of  a  bruise. 

Treat7}ie7it. — Such  wounds  are  best  treated  by  directing 
upon  the  wounded  part  a  stream  of  water,  as  hot  as  the  patient 
can  bear  it,  for  several  minutes.  This  will  favor  the  carrying 
off  of  the  escaped  blood.  Then,  after  bathing  the  part  freely 
with  phenol  sodique  or  laudanum,  wrap  in  hot,  wet  cloths. 


WEIGHTS  AND  MEASURES. 

APOTHECARIES'  WEIGHT. 

20  grains  (gr.)  make  I  scruple, sc.  or  ^ 

3  scruples        make  I  drachm, dr.  or  ^ 

8  drachms       make  I  ounce,        oz.  or  ^^ 

12  ounces  make  I  pound lb.  or  lb 


SCALE 

OF 

■   COMPARISON. 

lb. 

k 

oz. 

dr. 

SO. 

gr- 

I 

= 

12 

= 

96 

= 

288 

^= 

5760 

I 

= 

8 

= 

24 

= 

480 

I 

=r 

'1 

I 

"^=r- 

60 
20 

APOTHECARIES'  OR  WINE  MEASURE. 
60  minims  (n\)  make  I  fl.  drachm,     . fl.  dr.  or  f  3 

8  fl.  drachms    make  i  fl.  ounce, fl.  oz.  or  f  5 

16  fl.  ounces       make  I  pint, O. 

8  pints  make  I  gallon, C. 

SCALE   OF   COMPARISON. 


Gallon. 

Pints. 

Fl.  ounces. 

Fl. 

drachms. 

Minims, 

C. 

0. 

fs 

f5 

m 

I         = 

8 

=         128         = 

1024 

= 

61440 

I 

=           16         = 

128 

= 

7680 

I         ^ 

8 

I 

=::= 

480 
60 

1 68 


APPENDIX. 


TROY  WEIGHT. 

24  grains  (gi.)       make  I  pennyweight,  .    .         .     . 

20  pennyweights  make  I  ounce,       

12  ounces  make  I  pound, 

3/^  grains  make  I  carat  (diamond  weight), 


dwt. 
oz. 

lb 

k. 


SCALE   OF    COMI'ARISON. 


H). 
I 


oz. 

12 
I 


dwt. 

240 

20 

I 


I  k.         = 


5760 

480 

24 


AVOIRDUPOIS  WEIGHT. 

16  drachms  (dr.)      make  I  ounce, oz. 

16  ounces  make  I  pound, lb. 

25  pounds  make  I  quarter, ,    .  qr. 

4  quarters  make  I  hundredweight,     .....  cwt. 

20  hundredweight  make  I  ton, T. 

100  pounds  make  I  cental, C. 


SCALE  OF 

COM? 

ARISON. 

T. 

cwt. 

qr. 

R). 

oz. 

dr. 

I 

=   20 

=   80   ^ 

2000 

= 

32000 

^= 

5 1 2000 

I 

=    4   = 

100 

= 

4000 

= 

25600 

I   ^ 

25 

— 

400 

= 

6400 

I 

:^ 

16 
I 

=r 

256 
16 

A  gallon  contains  eight  pints. 

A  pint  contains  sixteen  fluid  ounces. 

A  fluid  ounce  conta:ins  eight  fluid  drachms. 

A  fluid  drachm  contains  sixty  minims  (Hi). 


APPENDIX, 


169 


APPROXIMATE   MEASUREMENT. 

A  wineglass  contains  two  fluid  ounces. 

A  teacup  contains  four  fluid  ounces. 

A  teaspoon  of  powder  contains  one-half  drachm. 

A  tablespoon  of  powder  contains  two  drachms. 

One  drop  of  essential  oils  contains  one-half  minim. 

One  drop  of  water  contains  one  minim. 

From   Goidd^  s  Medical  Dictionary. 

The  following  table  of  approximate  and  exact  equivalents 
of  the  metric  and  common  weights  and  measures  may  prove 
serviceable : 

LENGTH. 

Accurate 
Unit  of  Measuretnent.  Approximate  Equivalent.     Equivalent. 

I  inch, 2j^  cubic  centimeters,     .    .  2.539 

I  centimeter  {-^\-q  meter),      .    .    .    .0.4  inch, 0-393 

I  yard, i  meter, 0.914 

I  meter  (39.37  inches), I  yard, I-093 

I  foot, 30  centimeters, 30.479 

I  kilometer  (looo  meters),    .    .    .    .  Y%  mile, 0.621 

I  mile, 1 1^  kilometer,      1. 609 


SURFACE, 

Acctirate 
Unit  of  Measure^nent.  Approximate  Equivaletit.     Equivalent. 

I  hectare  (10,000  sq.  meters),  .    .    .  2}^   acres, 2. 471 

I  acre, i  hectare, 0.404 


WEIGHT. 


Unit  of  Measurement.  Approximate  Equivalent 

I  gramme,       15^  grains, 

I  grain, 0.064  gramme,     .    . 

I  kilogramme  (1000  grammes),    .    .  2\  lbs.  avoirdupois, 

I  pound  avoirdupois, ^  kilogramme,    .    , 

I  ounce  avoirdupois  (437^  grains),  283^  grammes,     .    . 
I  ounce,  Troy  or  apothecary  (480 

grains), 31  grammes, 31-103 

12 


Accurate 
Equivalent. 

15-432 
0.064 
2.204 
0.453 

28.349 


I  70  APPENDIX. 


BULK. 

Accj4rate 
Utiit  of  Measurement.  Approximate  Equivalent.     Equivalent. 

I  cubic  centimeter, 0.06  cubic  inch, 0.061 

I  cubic  inch, I^K  cul)ic  centimeters,  ,    .    .  16.386 

I  liter  (1000  cubic  centimeters),  .    .  I   U.  S.  Standard  quart,      .    .    0.946 

I  United  States  quart, I  liter,       1-057 

I  fluid  ounce,      29^  cubic  centimeters,  .    .    .29.570 


INDEX. 


A. 

Abbreviations,  8 
Abrasion  of  the  teeth,  45 
Abscesses,  30 

alveolar,  30 

of  the  antrum  of  Highmore,  57 
Absorption  of  roots,  23 
Acetic  acid,  123 
Acids,  antidotes  for,  160 

burns  from,  143 

their  effect  upon  the  teeth.  65 
Aconite,  73 

Acute  inflammation,  28 
^ther,  74  »■ 

Alcohol,  89 
Alkalies,  160 

antidotes  for,  160 
Alum,  118 

Alveolar  abscesses,  30 
Alveolaris  pyorrhoea,  37 
Amelloblasts,  9 
Ammonia,  92 
Amyl  nitrite,  94 
Anaesthesia,  treatment  of  dangerous 

symptoms  in,  78 
Anaesthetics,  general,  74 

local,  74,  84 
Analgesics,  71 
Anatomy  of  the  teeth,  17 
Angle's  method  of  fixation,  52 
Anodynes,  71 
Anomalies  of  the  teeth,  26 
Antidotes,  160 
Antipyretics,  112 
Antipyrine,   112 
Antiseptic  mouth-washes,  45 
Antiseptics,  124 


Antizymotics,   124 

Antrum  of  Highmore,  diseases  of, 

57 
Apoplexy,  141 
Aristol,  130 
Arsenic,  104 

Articulation  of  the  teeth,  20 
Artificial  palates,  61 
respiration,  150 
Astringents,  116 
Atropine,  72 


Bandages,  152 
Belladonna,  72 
Bichloride  of  mercury,  125 
Bites,  dog,  161 

serpent  and  insect,  161-163 
Bleeding,  154 
Blood  stasis,  30 
Bromide  of  ethyl,  83 
Bromine,  bromides,  69 
Bruises,  167 
Burns,  141 

C. 

Calcareous  deposits,  63 
Calcification  of  the  pulp,  15 

of  the  teeth,  12,  13 
Campho-phenique,  134 
Camphor,  93 
Capsicum,  95 
Carbolic  acid,  1 21 
Caries  in  relation  to  sex,  43 

of  the  teeth,  41-45 


171 


172 


INDEX. 


Caries,  relative  location  of,  44 

therapeutics  of,  45 
Catalepsy,  143 
Cathartics,  137 
Caustics,  120 
Cementoblasts,  12 
Cementuni,  12,  13 
Chemical  irritants,  1 13 
Chloral,  70 
Chloride  of  ethyl,  86 

of  zinc,  107 
Chloroform,  79 

therapeutic  uses  of,  79 
Choking,  143 
Chronic  inflammation,  28 
Cimicifuga,  loi 
Cinchona,  98 
Cinnamon,  135 
Citrate  of  magnesia,  137 
Classification  of  the  teeth,  17,  i< 
Cleaning  teeth,  65 
Cleft  palate,  58 
Cloves,  oil  of,  96 
Cocaine,  84 
Collodion,  139 
Congestion,  30 
Contusions,  166 
Convulsions,  143 

in  teething,  22 
Corn  ergot,  1 19 
Corrosive  sublimate,  125 
Creasote,  133 
Crowns  of  teeth,  19 
Cuts,  166 
Cystic  tumors,  29 


D. 

Deaths  from  teething,  22 
Deciduous  teeth,  decalcification  of, 

23. 
germination  of,  9,  lo 

Defects  of  the  palatine  organs,  58 
Dental  abrasion,  45 
caries,  41,  45 

relative  location  of,  44 


Dental  caries,  therapeutics  of,  45 

erosion,  39 

medicine,  68 

pathology,  27 

periostitis,  34 

pulp,  14 

therapeutics,  27 
Dentinal  fibrils,  12 
Dentine,  14 

calcification  of,  12,  13 

formations,  35 

organ,  9 
Dentition,  21 

lesions  incident  to,  22 

second,  25 

third,  26 
Denture,  permanent,  17 

temporary,  17 
Development  of  teeth,  9 
Devitalization  of  pulp,  33 
Digitalis,  100 
Disease,  27 

Diseases  of  dental  pulp  and  mem- 
brane, 33 

of  hard  dental  structure,  41 

of  maxillary  bones,  46 
Disinfectants,  124 
Dislocation  of  the  inferior  maxillary, 

55 
treatment  of,  56 

Dislocations,  144 
Dover's  powders,  72 
Drowning,  treatment  of,  144 
Drugs,  miscellaneous,  138 


E. 


Electrozone,  136 

Emergencies,  141 

Enamel,  9,  13 

calcification  of,  12 
formation  of,  9,  ii 
organ,  9 

Enamelblasts,  9 

Epilepsy,  treatment  of,  i^ 

Epithelium,  9 


INDEX. 


173 


Epsom  salts,  137 

Epulis  tumors,  29 

Ergot,  119 

Erosion,  dental,  39 

Eruption  of  the  teeth,  21-23 

Escharotics,  120 

Ether,  74 

action  of,  76 

administration  of,  75 
Ethyl  bromide,  S^ 

chloride,  86 
Etiology  of  dental  caries,  37 
Eucaine  hydrochlorate,  "A,"  88 
Eucalyptus,   loi 
Eugenol,  96 

Exhaustion  from  heat,  15 1 
Exosto^is,  40 
Exposed  pulp,  ^s 
Extraction  of  teeth,  61 

hemorrhage  following,  63 
indications  justifying,  62, 
63 


Fainting,  151*' 

Ferrum,  103 

Fistula,  30 

Follicles  of  the  teeth,  9,  1 1 

Foreign  bodies  in  the  throat,  143 

Formalin,  13 1 

Formula  of  permanent  teeth,  17 

of  temporary  teeth,  17 
Fowler's  solution,  104 
Fractures,  152 

of  alveolar  process,  46 

of  maxillae,  46 

treatment  of,  47-54 
Freezing,  154 

the  gum  before  extracting,  87 


G. 

Gallic  acid,  117 
Gangrene  of  the  pulp,  36 
Gas,  administration  of,  82 
liquefied,  81 


Gas,  mortality  of,  83 

nitrous  oxide,  80 
Gases,  noxious,  153 
Gaultheria,  132 
Germination  of  the  teeth,  9 
Glacial  phosphoric  acid,  1 10 
Glycerin,  138 


H. 

Haemostatics,  1 19 

Hard  dental  structure,  diseases  of, 

41 
Heat-stroke,  151 
Hemorrhage,  154 

after  extraction,  63,  157 

from  lungs,  157 

from  nose,  156 

from  stomach,  157 
Hydrochloric  acid,  ill 
Hydrogen  peroxide,  124 
Hydrophobia,  161 

treatment  of,  163 
Hypercementosis,  40 
Hypertrophy,  28 

of  the  pulp,  34 
yypnotics,  68 


Incised  wounds,  166 
Induration,  29 
Inflammation,  27 

acute,  27 

chronic,  28 

of  the  pericemental  membrane, 
36 

of  the  pulp,  ss 

of  the  temporo-maxillary  artic- 
ulation, 56 
Injuries  and  diseases  of  maxillary 

bones,  46 
Interdental  splints,  49,  50 
Interglobular  spaces,  13 
Intoxication,  158 
Iodine,  1 14 


174 


INDEX. 


Iodoform,  129 
Iron,  103 
Irritants,  113 
Irritation  of  pulp,  1 6 


Lacerated  wounds,  166 
Lancing  of  gums,  23 
Laxatives,  137 
Lunar  caustic,  120 


M. 

Magnesia,  137 

Materials  used  for  splints,  152 
Maxillary  bones,  diseases  and  inju- 
ries of,  46 
Mechanical  irritants,  1 13 
Medicine,  dental,  68 
Membrane,  pericemental,  16 
Miscellaneous  drugs,  138 
Monsel's  solution,  103 
Morphine,  71 
Mouth-washes,  45 
Mucous  deposits,  66 

effects  of,  upon  the  teeth, 
66 
Myrrh,  95 


N. 

Naphthol,  134 

Narcotics,  68 

Nausea,  treatment  of,  158 

Necrosis  of  the  jaws,  54 

Nervous  irritants,  II3 

Nitrate  of  silver,  120 

Nitric  acid,  109 

Nitrite  of  amyl,  94 

Nitrous  oxide  as  an  anaesthetic,  81 

manner  of  preparation  of, 
80 

mode  of  administering,  82 

mortality  of,  83 
Nodular  dentine,  35 


Nut-galls,  116 
Nux  vomica,  99 


Obturators,  61 
Occlusion  of  the  teeth,  20 
Odontalgia,  45 
Odontoblasts,  12 
Oil  of  cloves,  96 

of  eucalyptus,  loi 
Opium,  71 
Organ,  dentine,  9 

enamel,  9 
Oxychloride  of  zinc,  108 
Oxyphosphate  of  zinc,  108 


Pain  after  filling,  34 
Palates,   artificial,  61 
Palatine  organs,  defects  of,  58 
Papilla,  dentinal,  9 
Paralysis,  141 
Pathology,  dental,  27 
Peppermint,  97 
Pericementitis,  36 
Peridental  membrane,  16 
Permanent  denture,  17 
tooth  follicles,  II 
Permanganate  of  potassa,  128 
Peroxide  of  hydrogen,  126 

of  sodium,  128 
Persulphate  of  iron,  104 
Peruvian  bark,  98 
Phenol  sodique,  122 
Phosphoric  acid,  lio 
Physical  effects    of  ansesthesia,  76, 

77,  83 
Physiology  of  the  teeth,  13 
Pitch,  116 
Pitted  teeth,  13 

Poisons  and  their  antidotes,  158 
Polypus,  35 
Primary  dentition,  21 
Prophylaxis,  45 


INDEX. 


175 


Proximal  surfaces,  43 
Pulp,  calcification  of,  15 
devitalization  of,  33 
diseases  of,  33 
exposure  of,  ;^;^ 
gangrene  of,  36 
hypertrophy  of,  34 
inflammation  of,  33 
irritation  of,  16 
nodules,  35 
structure  of,  15 
Purgatives,  137 
Pus  and  pus  formation,  28 
Pyorrhoea  alveolaris,  37 
Pyrozene,  127 


Quinine,  96 


R. 


Removal  of  temporar}-  teeth,  23 
Resolution,  28 
Respiration,  Artificial,  150 
Resuscitation  from  drowning,  144 
Rhubarb,  137 


Saliva,  64 

Salivary  calculus,  63,  65 

Sandarach,  139 

Sanguinary  calculus,  66 

Scalds,  treatment  of,  142 

Sea-sickness,  163 

Second  dentition,  25 

Sedatives,  ill 

Senna,  137 

Setting  of  fractures,  47,  152 

Shedding  of  temporary  teeth,  23 

Snake  bites,  161 

Sodium  peroxide,  128 

Splints,  49,  154 

Sprains,  1 64 

Staphylorrhaphy,  60 

Starvation,  164 


Stimulants,  89 
Strangulation,    164 
Structure  of  the  pulp,  15 

of  the  teeth,  13 
Strychnine,  99 
Styptics,  119 
Suffocation  from  gas,  164 
Sulphate  of  iron,  104 

of  magnesia,  137 
Sulphuric  acid,  loS 

aromatic,  108 
Sun-stroke,  treatment  of,  165 
Supernumerary  teeth,  26 
Suppuration,  28 
Surface  of  teeth,  20 


Tannic  acid,  1 16 

Tartar  of  salivary  calculus,  63 

Teeth,  anatomy  of,  1 7 

articulation  of,  20 

calcification  of,  12,  13 

cementum  of,  13 

classification  of,  17,  18 

crowns  of,  19 

decalcification  of,  23 

dentine  of,  13 

development  of,  9 

enamel  of,  9,  13 

eruption  of,  21,  23 

exposed  pulp  of,  ^;^ 

extraction  of,  61 

follicles  of,  II 

germination  of,  9 

occlusion  of,  20 

permanent,  eruption  of.  25 

primary,  eruption  of,  21 

pulp  of,  15 

relative  proportion  of  roots  and 
crowns  of,  17-20 

structure  of,  13 

supernumerary,  26 

surfaces  of,  20 

temporary,  17 

absorption  of,  23 


176 


INDEX. 


Teething,  21 

convulsions  in,  22 

deaths  from,  22 

treatment  during,  22 
Temporary  denture,  17 
Therapeutics,  27 

of  caries,  46 
Third  dentition,  26 
Tonics,  97 
Tooth  powder,  45 

pulp,  15 
Tourniquet,  improvised,  156 
Trichloracetic  acid,  123 
Tumefaction,  29 
Turpentine,  115 


U. 

Ulceration,  32 

Use  of  tooth-brushes,  45 


V. 

Vascular  tumors,  30 
Velum,  artificial,  61 
Vital  force,  21 
Vomiting,  to  allay,  158 
to  produce,  158 

W. 

Weights  and  measures,  167 
Wounds,  contused,  166 

incised,  166 

lacerated,  166 

Z. 

Zinc,  106 

chloride,  107 
oxychloride  of,  108 
oxyphosphate  of,  108 


Catalogrue  No.  8.  December,  1899. 


CLASSIFIED  SUBJECT 
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SUBJECT.  PAGE 

Alimentary  Canal  (see  Surgery)  19 
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Anesthetics 3 

Autopsies  (see  Pathology) 16 

Bacteriology  (see  Pathology)..  16 

Bandaging  (see  Surgery) 19 

Brain  4 

Chemistry 4 

Children,  Diseases  of 6 

Clinical  Charts 6 

Compends 22,  23 

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Dentistry 7 

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Diagrams  (see  Anatomy,  page 
J,  and  Obstetrics,  page  16). 

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neous)    14 

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Eye 9 

Fevers 9 

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Insanity  4 

Latin,  Medical  (see  Miscella- 
neous and  Pharmacy) 14, 16 

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Massage 12 

Materia  Medica 12 

Medical  Jurisprudence 13 

Microscopy  13 

Milk  Analysis  (see  Chemistry)      4 
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Spine  (see  Nervous  Diseases)  14 
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turer.    Illustrated.  ^i-So 

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GROVES  AND  THORP.     Chemical  Technology.     The  Appli- 

cation  of    Chemistry   to  the   Arts  and    Manufactures. 
Vol.  I.   Fuel  and  Its  Applications.     607  Illustrations  and  4  Plates. 

Cloth,  $5.00;  Half  Morocco,  $6.50 
Vol.11.  Lighting.  Illustrated.  Cloth,  ^[4. 00;  Half  Morocco,  $5.50 
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Vol.  IV.   Electric  Lighting.  hi  Press. 

HOLLAND.  The  Urine,  the  Gastric  Contents,  the  Common 
Poisons,  and  the  Milk.  Memoranda,  Chemical  and  Microscopi- 
cal, for  Laboratory  Use.     6th  Ed.     Illustrated  and  interleaved,  $1.00 

LEFFMANN.  Compend  of  Medical  Chemistry,  Inorganic 
and  Organic.  Including  Urine  Analysis.  4th  Edition,  Rewritten 
and  Revised.  .80;  Interleaved,  ^1.25 

LEFFMANN.  Analysis  of  Milk  and  Milk  Products.  Arranged 
to  Suit  the  Needs  of  Analytical  Chemists,  Dairymen,  and  Milk  Inspec- 
tors.    2d  Edition.     Enlarged,  Illustrated.  $1-25 

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poses.    Illustrated.     4th  Edition,    fust  Ready.  ^i.25 

LEFFMANN.  Structural  Formulae.  Including  180  Structural 
and  Stereo-Chemical  Formulae.     lamo.  Interleaved.  ^i.oo 

MUTER.  Practical  and  Analytical  Chemistry.  2d  American 
from  the  Eighth  English  Edition.  Revised  to  meet  the  requirements 
ot  American  Medical  Colleges  by  Claude  C.  Hamilton,  m.d.  56 
Illustrations.  $1-25 

OETTEL.     Exercises  in  Electro-Chemistry.     Illustrated.        .75 

OETTEL.     Electro-Chemical  Experiments.     Illustrated.         .75 

RICHTER.  Inorganic  Chemistry.  4th  American,  from  6th  Ger- 
man Edition.  Authorized  translation  by  Edgar  F.  Smith,  m.a., 
PH.D.     89  Illustrations  and  a  Colored  Plate.  ^1-75 

RICHTER.  Organic  Chemistry.  3d  American  Edition.  Trans, 
from  the  8th  German  by  Edgak  F.  Smith.  Illustrated.  2  Volumes. 
Vol.    I.    Aliphatic  Series,     625  Pages.    Just  Ready.  $3.00 

Vol.11.    Carbocyclic  Series.  Nearly  Ready. 

SMITH.  Electro-Chemical  Analysis.  2d  Edition,  Revised.  28 
Illustrations.  ^1.25 

SMITH  AND  KELLER.  Experiments.  Arranged  for  Students 
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STAMMER.     Chemical  Problems.     With  Answers.  .50 


SUBJECT  CATALOGUE. 


SUTTON.  Volumetric  Analysis.  A  Systematic  Handbook  for 
the  Quantitative  Estimation  of  Chemical  Substances  by  Measure, 
Applied  to  Liquids,  Solids,  and  Gases.  7th  Edition,  Revised.  112 
Illustrations.  $4.50 

SYMONDS.  Manual  of  Chemistry,  for  Medical  Students. 
2d  Edition.  ^2.00 

TRAUBE.  Physico-Chemical  Methods.  Translated  by  Hardin. 
97  Illustrations.  $1.50 

THRESH.     Water  and  Water  Supplies.    2d  Edition.  $2.00 

ULZER  AND   FRAENKEL.     Chemical  Technical  Analysis. 

Translated  by  Fleck.     Illustrated.  $1.25 

WOODY.     Essentials    of    Chemistry    and    Urinalysis.      4th 

Edition.     Illustrated.  In  Press. 

***  Special  Catalogue  of  Books  on  Chemistry  free  upon  application. 

CHILDREN. 

CAUTLIE.  Feeding  of  Infants  and  Young  Children  by  Nat- 
ural and  Artificial  Methods.  $2.00 

HALE.     On  the  Management  of  Children.  .50 

HATFIELD.  Compend  of  Diseases  of  Children.  With  a 
Colored  Plate.     2d  Edition.  .80;    Interleaved,  $1.25 

MEIGS.  Infant  Feeding  and  Milk  Analysis.  The  Examination 
of  Human  and  Cow's  Milk,  Cream,  Condensed  Milk,  etc.,  and 
Directions  as  to  the  Diet  of  Young  Infants.  .50 

POWER.  Surgical  Diseases  of  Children  and  their  Treat- 
ment by  Modern  Methods.     Illustrated.  ^2.50 

STARR.  The  Digestive  Organs  in  Childhood.  The  Diseases  of 
the  Digestive  Organs  in  Infancy  and  Childhood.  With  Chapters  on 
the  Investigation  of  Disease  and  the  Management  of  Children.  2d 
Edition,  Enlarged.  Illustrated  by  two  Colored  Plates  and  numerous 
Wood  Engravings.  $2.00 

STARR.  Hygiene  of  the  Nursery.  Including  the  General  Regi- 
men and  Feeding  of  Infants  and  Children,  and  the  Domestic  Manage- 
ment of  the  Ordinary  Emergencies  of  Early  Life,  Massage,  etc.  6th 
Edition.     25  Illustrations.  $1.00 

SMITH.     Wasting  Diseases  of  Children.    6th  Edition.        J2.00 

TAYLOR  AND  WELLS.  The  Diseases  of  Children.  Illus- 
trated.    A  New  Manual.     746  pages.    Just  Ready.  ^4.00 

CLINICAL  CHARTS. 

GRIFFITH.  Graphic  Clinical  Chart  for  Recording  Temper- 
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Occupation,  Name,  etc.  Printed  in  three  colors.  Sample  copies 
free.  Put  up  in  loose  packages  of  fifty,  .50.  Price  to  Hospitals,  500 
copies,  $4.00;  1000  copies,  $7.50.  With  name  of  Hospital  printed 
on,  .50  extra. 

KEEN'S  CLINICAL  CHARTS.  Seven  Outline  Drawings  of  the 
Body,  on  which  may  be  marked  the  Course  of  Disease,  Fractures, 
Operations,  etc.  Pads  of  fifty,  $i.co.  Each  Drawing  may  also  be 
had  separately,  twenty-five  to  pad,  25  cents. 


MEDICAL  BOOKS. 


SCHREINER.  Diet  Lists.  Arranged  in  the  form  of  a  chart. 
With  Pamphlets  of  Specimen  Dietaries.     Pads  of  50.  .75 

DENTISTRY. 

special  Catalogue  0/  Dental  Books  sent  free  upon  application. 

BARRETT.  Dental  Surgery  for  General  Practitioners  and 
Students  of  Medicine  and  Dentistry.  Extraction  of  Teeth, 
etc.     3d  Edition.     Illustrated.  Nearly  Ready. 

BLODGETT.  Dental  Pathology.  By  Albert  N.  Blodgktt, 
M.D.,  late  Professor  of  Pathology  and  Therapeutics,  Boston  Dental 
College.     33  Illustrations.  ^1-25 

BROOMELL.  Anatomy  and  Histology  of  the  Human  Mouth 
and  Teeth.     284  Handsome  Illustrations.  ?4'50 

FLAGG.  Plastics  and  Plastic  Filling,  as  Pertaining  to  the  Filling 
of  Cavities  in  Teeth  of  all  Grades  of  Structure.     4th  Edition.       $A-<x> 

FILLEBROWN.      A    Text-Book    of    Operative     Dentistry. 

Written  by  invitation  of  the  National  Association  of  Dental  Facul- 
ties.    Illustrated.  $2-25 
QORGAS.     Dental  Medicine.     A  Manual  of  Materia  Medica  and 
Therapeutics.     6th  Edition,  Revised.          Cloth,  ^4.00;  Sheep,  $5.00 

HARRIS.  Principles  and  Practice  of  Dentistry.  Including 
Anatomy,  Physiology,  Pathology,  Therapeutics,  Dental  Surgery, 
and  Mechanism.  13th  Edition,  Revised  by  F.  J.  S.  Gorgas,  m.d., 
D.D.s.     1250   Illustrations.  Cloth,  J;6.oo;  Leather,  $7.00 

HARRIS.  Dictionary  of  Dentistry.  Including  Definitions  of  Such 
Words  and  Phrases  of  the  Collateral  Sciences  as  Pertain  to  the  Art  and 
Practice  of  Dentistry.  6th  Edition.  Revised  and  Enlarged  by  Fer- 
dinand ^.  S.  Gorgas,  m.d.,  d.d.s.         Cloth,  ^5.00;  Leather,  ^6.00 

HEATH.     Injuries  and  Diseases  of  the  Jaws.  4th  Edition.  187 

Illustrations.  l4-50 

HEATH.     Lectures  on   Certain   Diseases   of  the  Jaws.      64 

Illustrations.  Boards,  .50 

RICHARDSON.  Mechanical  Dentistry.  7th  Edition.  Thor- 
oughly Revised  and  Enlarged  by  Dr.  Geo.  W.  Warren.  691  Illus- 
trations. Cloth,  $5.00;  Leather,  $6.00 

SEWELL.  Dental  Surgery.  Including  Special  Anatomy  and 
Surgerj'.     3d  Edition,  with  200  Illustrations.  |2.oo 

SMITH.     Dental  Metallurgy.     Illustrated.  ^1.75 

TAFT.     Index  of  Dental  Periodical  Literature.  ^2.00 

TALBOT.     Irregularities  of  the  Teeth  and  Their  Treatment. 

2d  Edition.     2:54  Illustrations.  ^3-oo 

TOMES.     Dental  Anatomy.    Human  and  Comparative.    263  Illus- 
trations.    5th  Edition.  I4.00 
TOMES.     Dental  Surgery.     4th  Edition.     289  Illustrations.     $4.00 

WARREN.  Compend  of  Dental  Pathology  and  Dental  Medi- 
cine.    With  a  Chapter  on  Emergencies.     3d  Edition.     Illustrated. 

.80;  Interleaved,  $1.25 

WARREN.  Dental  Prosthesis  and  Metallurgy,  129  Ills.  $1.25 

WHITE.     The  Mouth  and  Teeth.     Illustrated.  .40 

***  Special  Catalogue  of  Dental  Bookt/ree  upon  application. 


SUBJECT  CATALOGUE. 


DICTIONARIES. 

GOULD.  The  Illustrated  Dictionary  of  Medicine,  Biology, 
and  Allied  Sciences.  Being  an  Exhaustive  Lexicon  of  Medicine 
and  those  Sciences  Collateral  to  it:  Biology  (Zoology  and  Botany), 
Chemistry,  Dentistry,  Parmacology,  Microscopy,  etc.,  with  many 
useful  Tables  and  numerous  fine  Illustrations.  1633  pages.  4th  Ed. 
Sheep  or  Half  Dark  Green  Leather,  «io.oo;   Thumb  Index,  $ii.cx> 

Half  Russia,  Thumb  Index,  Jlia.oo 

GOULD.  The  Medical  Student's  Dictionary.  Including  all  the 
Words  and  Phrases  Generally  Used  in  Medicine,  with  their  Proper 
Pronunciation  and  Definition,  Based  on  Recent  Medical  Literature. 
With  Tables  of  the  Bacilli,  Micrococci,  Mineral  Springs,  etc.,  of  the 
Arteries,  Muscles,  Nerves, Ganglia,  and  Plexuses,  etc.  loth  Edition. 
Rewritten  and  Enlarged.  Completely  reset  from  new  type.  700  pp. 
Half  Dark  Leather,  J3.25  ;  Half  Morocco,  Thumb  Index,  $4.00 

GOULD.  The  Pocket  Pronouncing  Medical  Lexicon.  3d  Edi- 
tion. (29,000  Medical  Words  Pronounced  and  Defined.)  Containing 
all  the  Words,  their  Definition  and  Pronunciation,  that  the  Medical, 
Dental,  or  Pharmaceutical  Student  Generally  Comes  in  Contact 
With ;  also  Elaborate  Tables  of  the  Arteries,  Muscles,  Nerves, 
Bacilli,  etc.,  etc.,  a  Dose  List  in  both  English  and  Metric  Systems, 
etc.,  Arranged  in  a  Most  Convenient  Form  for  Reference  and  Memor- 
izing. A  new  Edition  from  new  type,  enlarged  by  225  pages. 
fust  Ready. 

Full  Limp  Leather,  Gilt  Edges,  $1.00  ;  Thumb  Index,  $1.25 
95,000  Copies  of  Gould's  Dictionaries  Have  Been  Sold. 
*i^  Sample  Pages   and    Illustrations  and    Descriptive   Circulars    ot 

Gould's  Dictionaries  sent  free  upon  application. 

HARRIS.  Dictionary  of  Dentistry.  Including  Definitions  of  Such 
Words  and  Phrases  of  the  Collateral  Sciences  as  Pertain  to  the  Art 
and  Practice  of  Dentistry.  6th  Edition.  Revised  and  Enlarged  by 
Ferdinand  J.  S.  GoRGAS,  M.D.,  D.D.s.    Cloth,  J5. 00;  Leather,  $6.00 

LONGLEY.  Pocket  Medical  Dictionary.  With  an  Appendix, 
containing  Poisons  and  their  Antidotes,  Abbreviations  used  in  Pre- 
scriptions, etc.  Cloth,  .75  ;  Tucks  and  Pocket,  $1.00 

MAXWELL.      Terminologia    Medica    Polyglotta.        By   Dr. 

Thhodork  Maxwell,  Assisted  by  Others.  $3.00 

The  object  of  this  work  is  to  assist  the  medical  men  ot  any  nationality 

in   reading   medical  literature   written   in  a  language  not   their  own. 

Each  term  is  usually  given  in  seven  languages,  viz. :  English,  French, 

German,  Italian,  Spanish,  Russian,  and  Latin. 

TREVES  AND  LANG.    German-English  Medical  Dictionary. 

Half  Russia,  $3.25 

KAR  (see  also  Throat  and  Nose). 

BURNETT.     Hearing  and  How  to  Keep  It.     Illustrated.  .40 

DALBY.  Diseases  and  Injuries  of  the  Ear.  4th  Edition.  38 
Wood  Engravings  and  8  Colored  Plates.  $2.50 

HOVELL.  Diseases  of  the  Ear  and  Naso-Pharynx.  Includ- 
ing Anatomy  and  Physiology  of  the  Organ,  together  with  the  Treat- 
ment of  the  Affections  of  the  Nose  and  Pharynx  which  Conduce  to 
Aural  Disease.     122  Illustrations.     2d  Edition.  Preparing. 

PRITCHARD.  Diseases  of  the  Ear.  3d  Edition,  Enlarged. 
Many  Illustrations  and  Formulae.  $1.50 

WOAKES.  Deafness,  Giddiness,  and  Noises  in  the  Head. 
4th  Edition.     Illustrated.  $2.00 


MEDICAL  BOOKS. 


ELECTRICITY. 

BIGELOW.  Plain  Talks  on  Medical  Electricity  and  Bat- 
teries. With  a  Therapeutic  Index  and  a  Glossary.  43  Illustra- 
tions.    2d  Edition.  $1.00 

HEDLEY.  Therapeutic  Electricity  and  Practical  Muscle 
Testing.     99  Illustrations.  I2.50 

JONES.    Medical  Electricity.  3d  Edition.   112  Illus.         In  Press. 

MASON.    Medical  Electricity.     Numerous  Illustrations.  .75 

EYE. 

A  Special  Circular  of  Books  on  the  Eye  sent  free  upon  application. 

ARLT.  Diseases  of  the  Eye.  Clinical  Studies  on  Diseases  of  the 
Eye:     Translation  by  Lyman  Ware.  m.d.     Illustrated.  |i-25 

DONDERS.  The  Nature  and  Consequences  of  Anomalies  of 
Refraction.     With  Portrait  and  other  Illustrations.     8vo. 

Just  Ready.     Half  Morocco,  $1.25 

PICK.  Diseases  of  the  Eye  and  Ophthalmoscopy.  Trans- 
lated by  A.  B.  Hale,  m.  d.  157  Illustrations,  many  of  which  are  in 
colors,  and  2  glossary.  Cloth,  I4.50  ;  Sheep,  $5.50 

GOULD  AND  PYLE.  Compend  of  Diseases  of  the  Eye  and 
Refraction.  Including  Treatment  and  Operations,  and  a  Section 
on  Local  Therapeutics.  With  Formulae,  Useful  Tables,  a  Glossary, 
and  III  Illus.,  several  of  which  are  in  colors.     2d  Ed.    Just  Ready. 

Cloth,  .80 ;  Interleaved,  I1.25 

GOWERS.  Medical  Ophthalmoscopy.  A  Manual  and  Atlas 
with  Colored  Autotype  and  Lithographic  Plates  and  Wood-cuts, 
Comprising  Original  Illustrations  of  the  Changes  of  the  Eye  in  Dis- 
eases of^he  Brain,  Kidney,  etc.     3d  Edition.  l4-oo 

HARLAN.    Eyesight,  and  How  to  Care  for  It.    Illus.  .40 

HARTRIDGE.     Refraction.     104   Illustrations   and   Test  Types. 

9th  Edition,  Enlarged.  ^i-SO 

HARTRIDGE.      On  the  Ophthalmoscope.     3d  Edition.    With 

4  Colored  Plates  and  68  Wood-cuts.  $i-5o 

HANSELL  AND  REBER.     Muscular  Anomalies  of  the  Eye. 

Illustrated.  I1.50 

HANSELL  AND  BELL.      Clinical  Ophthalmology.     Colored 

Plate  of  Normal  Fundus  and  120  Illustrations.  $1.50 

JESSOP.  Manual  of  Ophthalmic  Surgery  and  Medicine.  Col- 
ored Plates  and  108  other  Illustrations.    Just  Ready.        Cloth,  $3  00 

MORTON.  Refraction  of  the  Eye.  Its  Diagnosis  and  the  Cor- 
rection of  its  Errors.     6th  Edition.  |i.oo 

OHLEMANN.  Ocular  Therapeutics.  Authorized  Translation, 
and  Edited  by  Dr.  Charles  A.  Oliver.    Just  Ready.  $i-75 

PHILLIPS.  Spectacles  and  Eyeglasses.  Their  Prescription 
and  Adjustment.     2d  Edition.     49  Illustrations.  ^i.oo 

SWANZY.  Diseases  of  the  Eye  and  Their  Treatment.  6th 
Edition,  Revised  and  Enlarged.  158  Illustrations,  i  Plain  Plate, 
and  a  Zephyr  Test  Card.  ^3.00 

THORINGTON.    Retinoscopy.    3d  Edition.     Illustrated.       Jr.cjo 

THORINGTON.  Refraction  and  How  to  Refract.  200  Illustra- 
tions,  13  of  which  are  Colored.     301  pages.    Just  Ready.  $1.50 

WALKER.  Students'  Aid  in  Ophthalmology.  Colored  Plate 
and  40  other  Illustrations  and  Glossary.  |i.So 


10  SUBJECT  CATALOGUE. 

FEVERS. 

COLLIE.  On  Fevers.  Their  History,  Etiology,  Diagnosis,  Prog- 
nosis, and  Treatment.     Colored  Plates.  |2.oo 

GOODALL  AND  WASHBOURN.  Fevers  and  Their  Treat- 
ment.    Illustrated.  l3-oo 

GOUT  AND  RHEUMATISM. 

DUCKWORTH,  A  Treatise  on  Gout.  With  Chromo-lithographs 
and  Engravings.  Cloth,  ^6.00 

GARROD.  On  Rheumatism.  A  Treatise  on  Rheumatism  and 
Rheumatic  Arthritis.  Cloth,  $5.00 

HAIG.  Causation  of  Disease  by  Uric  Acid.  A  Contribution  to 
the  Pathology  of  High  Arterial  Tension,  Headache,  Epilepsy,  Gout, 
Rheumatism,  Diabetes,  Bright's  Disease,  etc.     4th  Edition.       $3.00 

HEALTH    AND     DOMESTIC    MEDI- 
CINE (see  also  Hygiene  and  Nursing). 

BUCKLEY.    The  Skin  in  Health  and  Disease.     lUus.  ,40 

BURNETT.     Hearing  and  How  to  Keep  It.     Illustrated.  .40 

COHEN.     The  Throat  and  Voice.     Illustrated.  .40 

DULLES.     Emergencies.     4th  Edition.     Illustrated.  ^i.oo 
HARLAN.     Eyesight  and  How  to  Care  for  It.     Illustrated.     .40 

HARTSHORNE.     Our  Homes.     Illustrated.  .40 

OSGOOD.     The  Winter  and  its  Dangers.  .40 

PACKARD.     Sea  Air  and  Bathing.  .40 

PARKES.     The  Elements  of  Health.  $1.25 

RICHARDSON.     Long  Life  and  How  to  Reach  It.  .40 

WESTLAND.    The  ^Vife  and  Mother.  $1.50 

WHITE.     The  Mouth  and  Teeth.     Illustrated.  .40 

WILSON.     The  Summer  and  its  Diseases.  .40 

W^OOD.     Brain  W^ork  and  Overwork.  .40 

STARR.     Hygiene  of  the  Nursery.     5th  Edition.  fi.oo 

CANFIELD.     Hygiene  of  the  Sick-Room.  $1.25 

HEART. 

SANSOM.  Diseases  of  the  Heart.  The  Diagnosis  and  Pathology 
of  Diseases  of  the  Heart  and  Thoracic  Aorta.  With  Plates  and  other 
Illustrations.  $6.00 

THORNE,  The  Schott  Methods  of  the  Treatment  of  Chronic 
Heart  Disease.     Third  Edition.     Illustrated.    Just  Ready.     ^1.75 

HISTOLOGY. 

STIRLING.  Outlines  of  Practical  Histology.  368  Illustrations. 
2d  Edition,  Revised  and  Enlarged.     With  new  illustrations.       $2.00 

STOHR.  Histology  and  Microscopical  Anatomy.  Translated 
and  Exiited  by  A.  Schapkr,  m.d..  Harvard  Medical  School.  Second 
Edition,  Revised  and  Enlarged.    292  Illustrations.  $3-oo 


MEDICAL  BOOKS.  11 


HYGIENE  AND  WATER  ANALYSIS. 

special  Catalogue  of  Books  on  Hygiene  sent  free  upon  application. 

CANFIELD.  Hygiene  of  the  Sick-Room.  A  Book  for  Nurses 
and  Others.  Being  a  Brief  Consideration  of  Asepsis,  Antisepsis,  Dis- 
infection, Bacteriology,  Immunity,  Heating,  Ventilation,  etc.       $1.25 

COPLIN  AND  BEVAN,  Practical  Hygiene.  A  Complete 
American  Text-Book.     138  Illustrations.     New  Ed.  Preparing. 

KENWOOD.  Public  Health  Laboratory  "Work.  116  Illustra- 
tions and  3  Plates.  $2.00 

LEFFMANN.  Examination  of  'Water  for  Sanitary  and 
Technical  Purposes.    4th  Edition.   Illustrated.  Just  Ready.  ^1.25 

LEFFMANN.     Analysis  of  Milk  and  Milk  Products.      Illus- 
trated.    Second  Edition.  |i-25 
LINCOLN.    School  and  Industrial  Hygiene.  .40 
MACDONALD.      Microscopical  Examinations  of  Water  and 
Air.     25  Lithographic  Plates,  Eeference  Tables,  etc.    2d  Ed.     $2.50 

McNEILL.  The  Prevention  of  Epidemics  and  the  Construc- 
tion and  Management  of  Isolation  Hospitals.  Numerous  Plans 
and  Illustrations.  j3-50 

NOTTER  AND  FIRTH.  The  Theory  and  Practice  of  Hygiene. 
(Being  the  9th  Edition  of  Parkes'  Practical  Hygiene,  rewritten  and 
brought  up  to  date.)  10  Plates  and  135  other  Illustrations.  1034 
pages.     8vo.  ^7-oo 

PARKES.  Hygiene  and  Public  Health.  By  Louis  C.  Parkes, 
M.D.     5th  Edition.     Enlarged.     Illustrated.  $2.50 

PARKES.  Popular  Hygiene.  The  Elements  of  Health.  A  Book 
for  La^  Readers.     Illustrated.  $1-25 

STARR.  The  Hygiene  of  the  Nursery.  Including  the  General 
Regimen  and  Feeding  of  Infants  and  Children,  and  the  Domestic 
Management  of  the  Ordinary  Emergencies  of  Early  Life,  Massage, 
etc.     6th  Edition.     25  Illustrations.  ^i.oo 

STEVENSON  AND  MURPHY.    A  Treatise  on  Hygiene.    By 

Various  Authors.     In    Three    Octave   Volumes.     Illustrated. 

Vol.  I,  $6.00;  Vol.  II,  $6.00;  Vol.  Ill,  $5.00 

*#*  Each  Volume  sold  separately.   Special  Circular  upon  application. 

THRESH.     Water  and  Water  Supplies.     2d  Edition.  $2.00 

WILSON.  Hand-Book  of  Hygiene  and  Sanitary  Science. 
With  Illustrations.     8th  Edition.  $300 

WEYL.  Sanitary  Relations  of  the  Coal-Tar  Colors.  Author- 
ized Translation  by  Henry  Leffmann,  m.d.,  ph.d.  2i-25 

LUNGS  AND  PLEURiE. 

HARRIS  AND  BEALE.  Treatment  of  Pulmonary  Consump- 
tion.  $2.50 

KNOPF.  Pulmonary  Tuberculosis.  Its  Modern  Prophylaxis 
and  Treatment  in  Special  Institutions  and  at  Home.     Illus.        1^3  00 

POWELL.  Diseases  of  the  Lungs  and  Pleurae,  including 
Consumption.     Colored  Plates  and  other  Illus.     4th  Ed.  ^4.00 

TUSSEY.    High  Altitudes  in  the  Treatment  of  Consumption. 

I1.50 


12  SUBJECT  CATALOGUE. 

MASSAGE. 

KLEEN.  Hand-Book  of  Massage.  Authorized  translation  by 
MussKY  Hartwell,  M.D.,  PH.D.  With  an  Introduction  by  Dr.  S. 
Weir  Mitchell.  Illustrated  by  a  series  of  Photographs  Made 
Especially  by  Dr.  Kleen  for  the  American  Edition.  I2.25 

OSTROM.  Massage  and  the  Original  Srvedish  Move- 
ments. Their  Application  to  Various  Diseases  of  the  Body.  A 
Manual  for  Students,  Nurses,  and  Physicians.  Fourth  Edition,  En- 
larged.    105  Illustrations,  many  of  which  are  original.  |i.oo 

WARD.     Notes  on  Massage.     Interleaved.         Paper  cover,  ^i. 00 


MATERIA    MEDICA    AND     THERA- 
PEUTICS. 

ALLEN,  HARLAN,  HARTE,  VAN   HARLINQEN.   A 

Hand-Book  of  Local  Therapeutics,  Beinga  Practical  Description 
of  all  those  Agents  Used  in  the  Local  Treatment  of  Diseases  of  the 
Eye,  Ear,  Nose  and  Throat,  Mouth,  Skin,  Vagina,  Rectum,  etc., 
such  as  Ointments,  Plasters,  Powders,  Lotions,  Inhalations,  Supposi- 
tories, Bougies,  Tampons,  and  the  Proper  Methods  of  Preparing  and 
Applying  Them.  Cloth,  $3.00  ;  Sheep,  ^4.00 

BIDDLE.  Materia  Medica  and  Therapeutics.  Including  Dose 
List,  Dietary  for  the  Sick,  Table  of  Parasites,  and  Memoranda  of 
New  Remedies.  13th  Edition,  Thoroughly  Revised  in  accord- 
ance with  the  new  \J.  S.  P.     64  Illustrations  and  a  Clinical  Index. 

Cloth,  1^4.00;  Sheep,  $5.00 

BRACKEN.     Outlines  of  Materia  Medica  and  Pharmacology.    I2.75 
COBLENTZ.    The  Newer  Remedies.    3d  Edition,  Enlarged  and 
Revised.    Just  Heady.  $1.00 

DAVIS.     Materia  Medica  and  Prescription  Writing.        $1.50 
FIELD.     Evacuant  Medication.     Cathartics  and  Emetics.      J1.75 
GORQAS.     Dental  Medicine.     A  Manual  of  Materia  Medica  and 
Therapeutics.     6th  Edition,  Revised.  $4-oo 

GROFF.     Materia  Medica  for  Nurses.  $1.25 

HELLER.  Essentials  of  Materia  Medica,  Pharmacy,  and 
Prescription  W^riting.  $^-5° 

MAYS.     Theine  in  the  Treatment  of  Neuralgia.     J^  bound,  .50 
NAPHEYS.     Modern   Therapeutics.    Qth   Revised  Edition,  En- 
larged and  Improved.    In  two  handsome  volumes.     Edited  by  Allen 
J.  Smith,  m.d.,  and  J.  Aubrey  Davis,  m.d. 

Vol.  I.  General  Medicine  and  Diseases  of  Children.  ^4.00 

Vol,  II.  General  Surgery,  Obstetrics,  and  Diseases  of  Women.   ^4.00 

POTTER.  Hand-Book  of  Materia  Medica,  Pharmacy,  and 
Therapeutics,  including  the  Action  of  Medicines,  Special  Therapeu- 
tics, Pharmacology,  etc.,  including  over  600  Prescriptions  and  For- 
mulae. 7th  Edition,  Revised  and  Enlarged.  With  Thumb  Index  in 
each  copy.    Just  Ready.  Cloth,  J5. 00;  Sheep,  ;J6.oo 

POTTER.  Compend  of  Materia  Medica,  Therapeutics,  and 
Prescription  Writing,  with  Special  Reference  to  the  Physiologi- 
cal Action  of  Drugs.  6th  Revised  and  Improved  Edition,  based  upon 
the  U.  S.  P.  1890.  .80;   Interleaved,  $1.25 


MEDICAL  BOOKS.  13 


SAYRE.     Organic  Materia  Medica  and  Pharmacognosy.    An 

Introduction  to  the  Study  of  the  Vegetable  Kingdom  and  the  Vege- 
table and  Animal  Drugs.  Comprising  the  Botanical  and  Physical 
Characteristics,  Source,  Constituents,  and  Pharmacopeial  Prepara- 
tions, Insects  Injurious  to  Drugs,  and  Pharmacal  Botany.  With 
sections  on  Histology  and  Microtechnique,  by  W.  C.  Stevens. 
374  Illustrations,  many  of  which  are  original.    2d  Edition. 

Cloth,  $4.50 

WARING.  Practical  Therapeutics.  4th  Edition,  Revised  and 
Rearranged.  Cloth,  $2.00;  Leather,  I3. 00 

WHITE  AND  WILCOX.  Materia  Medica,  Pharmacy,  Phar- 
macology, and  Therapeutics.  4th  American  Edition,  Revised  by 
Reynold  W,  Wilcox,  m.a.,  m.d.,  ll.d.      Clo.,  $3.00;  Lea.,  J3.50 


MEDICAL    JURISPRUDENCE     AND 
TOXICOLOGY. 

REESE.  Medical  Jurisprudence  and  Toxicology.  A  Text-Book 
for  Medical  and  Legal  Practitioners  and  Students.  5th  Edition. 
Revised  by  Henry  Leffmann,  m.d.       Clo.,  ^3. 00;  Leather,  $3.50 

"  To  the  student  of  medical  jurisprudence  and  toxicology  it  is  in- 
valuable, as  it  is  concise,  clear,  and  thorough  in  every  respect." — The 
American  Journal  of  the  Medical  Sciences. 

MANN.     Forensic  Medicine  and  Toxicology.     Illus.  $6.50 

MURRELL.      What    to    Do    in    Cases    of   Poisoning.      8th 

Edition,  Enlarged.  ^i.oo 

TANNER.  Memoranda  of  Poisons.  Their  Antidotes  and  Tests. 
7th  Edition.  .75 

MICROSCOPY. 

BEALE.    The  Use  of  the  Microscope  in  Practical  Medicine. 

For  Students  and  Practitioners.with  Full  Directions  for  Examining  the 
Various  Secretions, etc.,  by  the  Microscope.  4th  Ed.   500  Illus.   J6.50 

BEALE.  How  to  Work  with  the  Microscope.  A  Complete 
Manual  of  Microscopical  Manipulation,  containing  a  Full  Description 
of  many  New  Processes  of  Investigation,  with  Directions  for  Examin- 
ing Objects  Under  the  Highest  Powers,  and  for  Taking  Photographs 
of  Microscopic  Objects.  5th  Edition.  400  Illustrations,  many  of 
them  colored.  $6- 5° 

CARPENTER.     The  Microscope  and    Its   Revelations.     8th 

Edition.     800  Illustrations  and  many  Lithographs.  Preparing. 

LEE.  The  Microtomist's  Vade  Mecum.  A  Hand-Book  of 
Methods  of  Microscopical  Anatomy.  887  Articles.  4th  Edition, 
Enlarged.  $4.00 

REEVES.  Medical  Microscopy,  including  Chapters  on  Bacteri- 
ology, Neoplasms,  Urinary  Examination,  etc.  Numerous  Illus- 
trations, some  of  which  are  printed  in  colors.  ^2.50 

WETHERED.  Medical  Microscopy.  A  Guide  to  the  Use  of  the 
Microscope  in  Practical  Medicine.     100  Illustrations.  ^2.00 


14  SUBJECT  CATALOGUE. 

MISCELLANEOUS. 

BLACK.  Micro-Organisms.  The  Formation  of  Poisons.  A 
Biological  Study  of  the  Germ  Theory  of  Disease.  .75 

BRAMWELL.     Anaemia.    Just  Ready.  ^2.50 

BURNETT.  Foods  and  Dietaries.  A  Manual  of  Clinical  Diet- 
etics.    2d  Edition.  |i-5o 

BUXTON.     Anaesthetics.     Illustrated,     3d  Edition.  In  Press. 

GOULD.  Borderland  Studies.  Miscellaneous  Addresses  and 
Essays.     i2mo.  ^2.00 

GOWERS.     The  Dynamics  of  Life.  .75 

HAIG.  Causation  of  Disease  by  Uric  Acid.  A  Contribution  to 
the  Pathology  of  High  Arterial  Tension,  Headache,  Epilepsy,  Gout, 
Rheumatism,  Diabetes,  Bright's  Disease,  etc.     4th  Edition.        $3.00 

HAIG.  Diet  and  Food.  Considered  in  Relation  to  Strength  and 
Power  of  Endurance.    Just  Ready.  Ji.oo 

HARE.     Mediastinal  Disease.     Illustrated  by  six  Plates.        %i.qo 

HEMMETER.  Diseases  of  the  Stomach.  Their  Special  Path- 
ology, Diagnosis,  and  Treatment.  With  Sections  on  Anatomy,  Diet- 
etics, Surgery,  etc.    2d  Edition.      Illustrated.     Clo.  $6.00;  Sh.  ^7.00 

HENRY.     A  Practical  Treatise  on  Anemia.  Half  Cloth,  .50 

LEFFMANN.  The  Coal-Tar  Colors.  With  Special  Reference  to 
their  Injurious  Qualities  and  the  Restrictions  of  their  Use.  A  Trans- 
lation of  Theodore  Weyl's  Monograph.  ^1.25 

MARSHALL.  History  of  Woman's  Medical  College  of  Penn- 
sylvania. |i-5o 

NEW  SYDENHAM  SOCIETY'S  PUBLICATIONS.  Circulars 
upon  application.  Per  Annum,  ^8.00 

TREVES.    Physical  Education  :  Its  Effects,  Methods,  Etc.  .75 
LIZARS.    The  Use  and  Abuse  of  Tobacco.  .40 

PARRISH.     Alcoholic  Inebriety.  ^i.oo 

ST.  CLAIR.     Medical  Latin.  ^1.00 

SCHREINER.     Diet  Lists.     Pads  of  50.  .75 

TURNBULL.    Artificial  Anaesthesia.    4th  Edition.    Illus.    $2.50 

NERVOUS  DISEASES. 

BEEVOR.  Diseases  of  the  Nervous  System  and  their  Treat- 
ment. $2.50 

GORDINIER.  The  Gross  and  Minute  Anatomy  of  the  Cen- 
tral Nervous  System.  With  271  original  Colored  and  other 
Illustrations.    Just  Ready.  Cloth,  ^600;   Sheep,  J7.C0 

GOWERS.  Manual  of  Diseases  of  the  Nervous  System.  A 
Complete  Text-Book.  Revised,  Enlarged,  and  in  many  parts  Re- 
written. With  many  new  Illustrations.  Two  volumes. 
Vol.  I.  Diseases  of  the  Nerves  and  Spinal  Cord.  3d  Edition,  En- 
larged. Just  Ready.  Cloth,  $4.00 ;  Sheep,  $5.00 
Vol.  II.  Diseases  of  the  Brain  and  Cranial  Nerves;  General  and 
Functional  Disease.     2d  Edition.  Cloth,  $4.00;  Sheep,  I5.00 

GOWERS.     Syphilis  and  the  Nervous  System.  $1.00 

GOWERS.  Diagnosis  of  Diseases  of  the  Brain.  2d  Edition. 
Illustrated.  $1.50 

GOWERS.  Clinical  Lectures.  A  New  Volume  of  Essays  on  the 
Diagnosis,  Treatment,  etc.,  of  Diseases  of  the  Nervous  System.  $2.00 

GOWERS.  Epilepsy  and  Other  Chronic  Convulsive  Diseases. 
2d  Edition.  In  Press. 


MEDICAL  BOOKS.  16 


HORSLEY.  The  Brain  and  Spinal  Cord.  The  Structure  and 
Functions  of.     Numerous  Illustrations.  |2.50 

ORMEROD.  Diseases  of  the  Nervous  System.  66  Wood  En- 
gravings. $i.oo 

OSLER.     Cerebral  Palsies  of  Children.     A  Clinical  Study.    $2.00 

OSLER.    Chorea  and  Choreiform  Affections.  $2.00 

PRESTON.  Hysteria  and  Certain  Allied  Conditions.  Their 
Nature  and  Treatment.     Illustrated.  $2.00 

WATSON.  Concussions.  An  Experimental  Study  of  Lesions  Aris- 
ing from  Severe  Concussions.  Paper  cover^  ^i.oo 

WOOD,     Brain  Work  and  Overwork.  .40 


NURSING. 

special  Catalogue  of  Books  for  Nurses  sent  free  upon  application. 

BROWN.     Elementary  Physiology  for  Nurses.  .75 

CANFIELD.  Hygiene  of  the  Sick-Room.  A  Book  for  Nurses  and 
Others.  Being  a  Briet  Consideration  of  Asepsis,  Antisepsis,  Disinfec- 
tion, Bacteriology,  Immunity,  Heating  and  Ventilation,  and  Kindred 
Subjects  for  the  Use  of  Nurses  and  Other  Intelligent  Women.     ^1.25 

CULLINGW^ORTH.  A  Manual  of  Nursing,  Medical  and  Sur- 
gical.    3d  Edition  with  Illustrations.  .75 

CULLINGWORTH.  A  Manual  for  Monthly  Nurses.  3d  Ed.  .40 
CUFF.     Lectures  to  Nurses  on  Medicine.     New  Ed.  $1.25 

DOMVILLE.  Manual  for  Nurses  and  Others  Engaged  in  At- 
tending the  Sick.  8th  Edition.  With  Recipes  for  Sick-room  Cook- 
ery etc.  .75 
FULLERTON,  Obstetric  Nursing.  41  Ills.  5th  Ed.  $1.00 
FULLERTON.  Surgical  Nursing.  Comprising  the  Regular 
Course  of  Instruction  at  the  Training-School  of  the  Woman's  Hos- 
pital, Philadelphia.     3d  Edition.     69  Illustrations.                          |i.co 

GROFF.  Materia  Medica  for  Nurses.  With  Questions  for  Self-Ex- 
amination  and  a  very  complete  Glossary.  $1.25 

HUMPHREY.  A  Manual  for  Nurses.  Including  General 
Anatomy  and  Physiology,  Management  of  the  Sick  Room,  etc. 
i6th  Ed.     Illustrated.  $1.00 

SHAWE.  Notes  for  Visiting  Nurses,  and  all  those  Interested 
in  the  Working  and  Organization  of  District,  Visiting,  or 
Parochial  Nurse  Societies.  With  an  Appendix  Explaining  the 
Organization  and  Working  of  Various  Visiting  and  District  Nurse  So- 
cieties, by  Helen  C.  Jenks,  of  Philadelphia.  $1.00 

STARR.  The  Hygiene  of  the  Nursery.  Including  the  General 
Regimen  and  Feeding  of  Infants  and  Children,  and  the  Domestic  Man- 
agement of  the  Ordinary  Emergencies  of  Early  Life,  Massage,  etc.  6th 
Edition.     25  Illustrations.  ^i.oo 

TEMPERATURE  AND  CLINICAL  CHARTS.    See  page  6. 
VOS^VINKEL.     Surgical    Nursing.     Second  Edition,  Enlarged. 
112  Illustrations.    Just  Ready.  |i.oo 

W^ARD.     Notes  on  Massage.     Interleaved.  Paper  cover,  |i.oo 


16  SUBJECT  CATALOGUE. 


OBSTETRICS. 

CAZEAUX  AND  TARNIER.  Midwifery.  With  Appendix  by 
MuNDft.  The  Theory  and  Practice  of  Obstetrics,  including  the  Dis- 
eases of  Pregnancy  and  Parturition,  Obstetrical  Operations,  etc. 
8th  Edition.  Illustrated  by  Chromo-Lithographs,  Lithographs,  and 
other  full-page  Plates,  seven  of  which  are  beautifully  colored,  and 
numerous  Wood  Engravings.  Cloth,  ^4.50  ;  Full  Leather,  J5.50 

DAVIS.  A  Manual  of  Obstetrics.  3d  Edition.  With  Colored 
and  many  other  Illustrations.  In  Press. 

LANDIS.  Compend  of  Obstetrics.  6th  Edition,  Revised  by  Wm. 
H.  Wells,  Assistant  Demonstrator  of  Clinical  Obstetrics,  Jefferson 
Medical    College.     With   47   Illustrations,    .80;    Interleaved,  $1.25. 

SCHULTZE.  Obstetrical  Diagrams.  Being  a  series  of  20  Col- 
ored Lithograph  Charts,  Imperial  Map  Size,  of  Pregnancy  and  Mid- 
wifery, with  accompanying  explanatory  (German)  text  illustrated 
by  Wood  Cuts.     2d  Revised  Edition. 

Price  in  Sheets,  1^26.00  ;  Mounted  on  Rollers,  Muslin  Backs,  $36.00 

STRAHAN.  Extra-Uterine  Pregnancy.  The  Diagnosis  and 
Treatment  of  Extra-Uterine  Pregnancy.  .75 

WINCKEL.  Text-Book  of  Obstetrics,  Including  the  Pathol- 
ogy and  Therapeutics  of  the  Puerperal  State.  Authorized 
Translation  by  J.  Clifton  Edgar,  a.m.,  m.d.  With  nearly  200  Illus- 
trations. Cloth,  $5.00;  Leather,  |6.oo 

FULLERTON.    Obstetric  Nursing.     5th  Ed.    Illustrated.    $1.00 

PATHOLOGY. 

BARLOW.     General  Pathology.     795  pages.    8vo.  $5-oo 

BLACKBURN.  Autopsies.  A  Manual  of  Autopsies  Designed  for 
the  Use  of  Hospitals  for  the  Insane  and  other  Public  Institutions. 
Ten  full-page  Plates  and  other  Illustrations.  $1-25 

BLODGETT.    Dental   Pathology.      33  Illustrations.  I1.25 

COPLIN.  Manual  of  Pathology.  Including  Bacteriology,  Technic 
of  Post-Mortems,  Methods  of  Pathologic  Research,  etc.     275  Illus- 
trations, many  of  which  are  original.     3d.  Edition.      Nearly  Ready. 
GILLIAM.     Pathology.  A  Hand-Book  for  Students.  47  Illus.     .75 
HALL.  Compend  of  General  Pathology  and  Morbid  Anatomy. 
91  very  fine  Illustrations.       2d  Edition.  .80:   Interleaved,  Jii. 25 

HEWLETT.     Manual  of  Bacteriology.     7s  Illustrations.    $3.00 
VIRCHOW.     Post-Mortem  Examinations.     A  Description  and 
Explanation  of  the  Method  of  Performing  Them  in  the  Dead  House 
of  the  Berlin  Charity  Hospital,  with  Special  Reference  to  Medico- 
Legal  Practice.     3d  Edition,  with  Additions.  .75 
WHITACRE.     Laboratory   Text-Book   of   Pathology.     With 
121  Illustrations.                                                                                          Jii-So 
WILLIAMS.     Bacteriology.     A  Manual  for  Students.     78   Illus- 
trations.                                                                                                     $1.50 

PHARMACY. 

special  Catalos^e  of  Books  on  Pharmacy  sent  free  upon  application. 

COBLENTZ.  The  Newer  Remedies.  Including  their  Synonyms, 
Sources,  Methods  of  Preparation,  Tests,  Solubilities,  and  Doses  as 
far  as  known.  Together  with  Sections  on  the  Organo-Therapeutic 
Agents  ard  Indifferent  Compounds  of  Iron.  Third  Edition,  very 
much  Enlarged.    Just  Ready.  Ji.oo 

COBLENTZ.  Manual  of  Pharmacy.  A  New  and  Complete 
Text-Book  by  the  Professor  in  the  New  York  College  of  Pharmacy. 
2d  Edition,  Revised  and  Enlarged.   437  Illus.   Cloth,  $3.50 ;  Sh.,  $4.50 


MEDICAL   BOOKS.  17 


BEASLEY.  Book  of  3100  Prescriptions.  Collected  from  the 
Practice  of  the  Most  Eminent  Physicians  and  Surgeons — English, 
French,  and  American.  A  Compendious  History  ol  the  Materia 
Medica,  Lists  of  the  Doses  of  all  the  Officinal  and  Established  Pre- 
parations, an  Index  of  Diseases  and  their  Remedies.     7th  Ed.     ^2.00 

BEASLrEY.  Druggists'  General  Receipt  Book.  Comprising 
a  Copious  Veterinary  Formulary,  Recipes  in  Patent  and  Proprietary 
Medicines,  Druggists'  Nostrums,  etc. ;  Perfumery  and  Cosmetics, 
Beverages,  Dietetic  Articles  and  Condiments,  Trade  Chemicals, 
Scientific  Processes,  and  many  Useful  Tables.     loth  Ed.  ^2.00 

BEASLEY.  Pharmaceutical  Formulary.  A  Synopsis  of  the 
British,  French,  German,  and  United  States  Pharmacopoeias.  Com- 
prising Standard  and  Approved  Formulae  for  the  Preparations  and 
Compounds  Employed  in  Medicine.  12th  Edition.  Just  Ready.  $2,00 

PROCTOR.  Practical  Pharmacy.  Lectures  on  Practical  Phar- 
macy. With  Wood  Engravings  and  32  Lithographic  Fac-simile 
Prescriptions.  3d  Edition,  Revised,  and  with  Elaborate  Tables  of 
Chemical  Solubilities,  etc.  ^3-oo 

ROBINSON.  Latin  Grammar  of  Pharmacy  and  Medicine. 
3d  Edition.     With  elaborate  Vocabularies.  |i-75 

SAYRE.  Organic  Materia  Medica  and  Pharmacognosy.  An 
Introduction  to  the  Study  of  the  Vegetable  Kingdom  and  the  Vege- 
table and  Animal  Drugs.  Comprising  the  Botanical  and  Physical 
Characteristics,  Source,  Constituents,  and  Pharmacopeial  Prepar- 
ations, Insects  Injurious  to  Drugs,  and  Parmacal  Botany.  With 
sections  on  Histology  and  Microtechnique,  by  W.  C.  Stevens. 
374  Illustrations.     Second  Edition.  Cloth,  ^4.50 

SCOVILLE.  The  Art  of  Compounding.  Second  Edition,  Re- 
vised and  Enlarged.  Cloth,  $2.50;  Sheep,  $3.50 

STEWART.  Compend  of  Pharmacy.  Based  upon  "  Reming- 
toTi's  Text-Book  of  Pharmacy."  5th  Edition,  Revised  in  Accord- 
ance with  the  U.  S.  Pharmacopoeia,  1890.  Complete  Tables  of 
Metric  and  English  Weights  and  Measures.     .80;    Interleaved,  I1.25 

UNITED  STATES  PHARMACOPCEIA.  1890.  7th  Decennial 
Revision.  Cloth,  J2.50  (postpaid,  $2.77);  Sheep,  ^3.00  (postpaid, 
$3.27);  Interleaved,  $4.00  (postpaid,  $4.50);  Printed  on  one  side  of 
page  only,  unbound,  ^3.50  (postpaid,  $3.90). 

Select  Tables  from  the  U.  S.  P.  (1890).  Being  Nine  of  the  Most 
Important  and  Useful  Tables,  Printed  on  Separate  Sheets.  Care- 
fully put  up  in  patent  envelope.  .25 

POTTER.  Hand-Book  of  Materia  Medica,  Pharmacy,  and 
Therapeutics.    600  Prescriptions.    7th  Ed.    Clo.,j5.oo;  Sh.,  |6.oo 

***  Special  Catalogue  of  Books  on  Pharmacy  free  upon  application. 

PHYSICAL  DIAGNOSIS. 

BRO^VN.  Medical  Diagnosis.  A  Manual  of  Clinical  Methods. 
4th  Edition.     112  Illustrations.  Cloth,  ^2.25 

FENWICK.  Medical  Diagnosis.  8th  Edition.  Rewritten  and 
very  much  Enlarged.     135  Illustrations.  Cloth,  ^2.50 

MEMMINGER.    Diagnosis  by  the  Urine.   2d  Ed.   24  Illus.  $1  00 

TYSON.     Hand-Book  of  Physical  Diagnosis.     For  Students  and 

Physicians.     By  the  Professor  of  Clinical  Medicine  in  the  University 

of  Pennsylvania.     Illus.     3d   Ed.,     Improved  and  Enlarged.     With 

Colored  and  other  Illustrations.  $i-5o 

2 


18  SUBJECT  CATALOGUE. 

PHYSIOLOGY. 

BIRCH.  Practical  Physiology.  An  Elementary  Class  Book. 
62  Illustrations.    Just  Ready.  %'^-lS 

BRUBAKER.  Compend  of  Physiology.  9th  Edition,  Revised 
and  Enlarged.     Illustrated.    Just  Ready.         .80;  Interleaved,  1^1.25 

KIRKE.  Physiology.  (15th  Authorized  Edition.  Dark-Red  Cloth.) 
A  Hand-Book  of  Physiology.  15th  Edition,  Revised,  Rearranged, 
and  Enlarged.  By  Prof.  W.  D.  Halliburton,  of  Kings  College, 
London.  661  Illustrations,  some  of  which  are  printed  in  colors. 
Just  Ready.  Cloth,  ^3.00;  Leather,  J3. 75 

LANDOIS.  A  Text-Book  of  Human  Physiology,  Including 
Histology  and  Microscopical  Anatomy,  with  Special  Reference  to 
the  Requirements  of  Practical  Medicine.  5th  American,  translated 
from  the  9th  German  Edition,  with  Additions  by  Wm.  Stirling, 
M.D.,D.sc.    845  lllus.,  many  of  which  are  printed  in  colors.    In  Press. 

STARLING.     Elements  of  Human  Physiology.     100  Ills.    |i.oo 

STIRLING.  Outlines  of  Practical  Physiology.  Including 
Chemical  and  Experimental  Physiology,  with  Special  Reference  to 
Practical  Medicine.     3d  Edition.     289  Illustrations.  $2.00 

TYSON.     Cell  Doctrine.     Its  History  and  Present  State.        I1.50 

PRACTICE. 

BEALE.    On  Slight  Ailments;  their  Nature  and  Treatment. 

2d  Edition,  Enlarged  and  Illustrated.  |i-25 

FOWLER.      Dictionary  of   Practical    Medicine.      By  various 

writers.  An  Encyclopaedia  of  Medicine.  Clo.,$3.oo;  Half  Mor.  ^4.00 

HUGHES.  Compend  of  the  Practice  of  Medicine.  6th  Edition, 
Revised  and  Enlarged.    Just  Ready. 

Part  I.  Continued,  Eruptive,  and  Periodical  Fevers,  Diseases  of  the 
Stomach,  Intestines,  Peritoneum,  Biliary  Passages,  Liver,  Kid- 
neys, etc.,  and  General  Diseases,  etc. 

Part  II.  Diseases  of  the  Respiratory  System,  Circulatory  System, 
and  Nervous  System;  Diseases  of  tlie  Blood,  etc. 

Price  of  each  part,  .80;  Interleaved,  $1.25 

Physician's  Edition.  In  one  volume,  including  the  above  two 
parts,  a  Section  on  Skin  Diseases,  and  an  Index.  6th  Revised 
Edition.     625  pp.    Just  Ready.        Full  Morocco,  Gilt  Edge,  J2.25 

ROBERTS.  The  Theory  and  Practice  of  Medicine.  The 
Sections  on  Treatment  are  especially  exhaustive.  9th  Edition, 
with  Illustrations.  Cloth,  I4. 50;  Leather,  ^5.50 

TAYLOR.     Practice  of  Medicine.     5th  Edition.  Cloth,  JJ4.00 

TYSON.  The  Practice  of  Medicine.  By  James  Tyson,  m.d.. 
Professor  of  Clinical  Medicine  in  the  University  of  Pennsylvania. 
A  Complete  Systematic  Text-book  with  Special  Reference  to  Diag- 
nosis and  Treatment.     Illustrated.     8vo. 

Cloth,  $5.50  ;  Leather,  $6.50 ;  Half  Russia,  $7.50 

PRESCRIPTION  BOOKS. 

BEASLEY.  Book  of  3100  Prescriptions.  Collected  from  the 
Practice  of  the  Most  Eminent  Physicians  and  Surgeons — English, 
French,  and  American.  A  Compendious  History  of  the  Materia, 
Medica,  Lists  of  the  Doses  of  all  Officinal  and  Established  Prepara- 
tions, and  an  Index  of  Diseases  and  their  Remedies.     7th  Ed.     I2.00 


MEDICAL  BOOKS.  19 


BEASLEY.  Druggists'  General  Receipt  Book.  Comprising 
a  Copious  Veterinary  Formulary,  Recipes  in  Patent  and  Proprie- 
tary Medicines,  Druggists'  Nostrums,  etc.  ;  Perfumery  and  Cos- 
metics, Beverages,  Dietetic  Articles  and  Condiments,  Trade  Chem- 
icals, Scientific  Processes,  and  an  Appendix  of  Useful  Tables, 
loth  Edition,  Revised.  $2.00 

BEASLEY.  Pocket  Formulary.  A  Synopsis  of  the  British,  French, 
German,  and  United  States  Pharmacopoeias  and  the  chief  unofficial 
Formularies.     12th  Edition.    Jjist  Ready.  $2.00 


SKIN. 

BULKLEY.    The  Skin  in  Health  and  Disease.    Illustrated.    .40 

CROCKER.  Diseases  of  the  Skin.  Their  Description,  Pathol- 
ogy, Diagnosis,  and  Treatment,  with  Special  Reference  to  the  Skin 
Eruptions  of  Children.    92  Illus.    3d  Edition.  Preparing. 

IMPEY.     Leprosy.     37  Plates.     8vo.  $3-5o 

SCHAMBERG.  Diseases  of  the  Skin.  99  Illustrations.  Being 
No.  16?  Quiz-Compend?  Series.  Cloth,  .80;  Interleaved,  $1.25 

VAN  HARLINGEN.  On  Skin  Diseases.  A  Practical  Manual 
of  Diagnosis  and  Treatment,  with  special  reference  to  DiflFerential 
Diagnosis.  3d  Edition,  Revised  and  Enlarged.  With  Formulae 
and   60  Illustrations,   some  of  which  are  printed  in  colors.         $2.75 

SURGERY  AND  SURGICAL   DIS- 
EASES (see  also  Urinary  Organs). 

BUTLIN.  Surgery  of  Malignant  Disease.  2d  Edition.  Illus- 
trated. Nearly  Ready. 

CRIPPS.  Ovariotomy  and  Abdominal  Surgery.  Illus.  ^8.00 
DEAVER.  Surgical  Anatomy.  A  Treatise  on  Human  Anatomy 
in  its  Application  to  Medicine  and  Surgery.  With  about  400  very 
Handsome  full-page  Illustrations  Engraved  from  Original  Drawings 
made  by  special  Artists  from  Dissections  prepared  for  the  purpose. 
Three  Volumes.  Royal  Square  Octavo.  \ cAwxnt.  \ ,  Just  Ready . 
Cloth,  $21. 00  ;  Half  Morocco  or  Sheep,  J24.00  ;  Half  Russia,  $27.00 

DEAVER.  Appendicitis,  Its  Symptoms,  Diagnosis,  Pathol- 
ogy. Treatm.ent,  and  Complications.  Elaborately  Illustrated 
with  Colored  Plates  and  other  Illustrations.  Cloth,  $3.50 

DULLES.  What  to  Do  First  in  Accidents  and  Poisoning. 
5th  Edition.     New  Illustrations.  $1,00 

FULLERTON.     Surgical  Nursing.     3d  Edition.    69  Illus.    $100 

HACKER.  Antiseptic  Treatment  of  Wounds,  According  to 
the  Method  in  Use  at  Professor  Billroth's  Clinic,  Vienna,  .50 

HAMILTON.  Lectures  on  Tumors,  from  a  Clinical  Stand- 
point.    Third  Edition,  Revised,  with  New  Illustrations.  $1.25 

HEATH.  Minor  Surgery  and  Bandaging,  nth  Ed.,  Revised 
and  Enlarged.     158  Illustrations,  62  Formulae,  Diet  List,  etc.      I1.25 

HEATH.  Injuries  and  Diseases  of  the  Jaws.  4th  Edition, 
187  Illustrations.  $450 

HEATH.  Lectures  on  Certain  Diseases  of  the  Jaws.  64  Illus- 
trations. Boards,  .50 


so  SUBJECT  CATALOGUE. 

HORWITZ.  Compend  of  Surgery  and  Bandaging,  including 
Minor  Surgery,  Amputations,  Fractures,  Dislocations,  Surgical  Dis- 
eases, and  the  Latest  Antiseptic  Rules,  etc.,  with  Differential  Diagno- 
sis and  Treatment.  5th  Edition,  very  much  Enlarged  and  Rear- 
ranged.    167  illustrations,  q8  Formulae.    Clo.,.8o;   Interleaved,  f  1.25 

JACOBSON.     Operations    of    Surgery.     Over  200   Illustrations. 

Cloth,  $3.00  ;   Leather,  $4.00 

JACOBSON.     Diseases  of  the   Male   Organs  of  Generation. 

88   Illustrations.  |6.oo 

LANE.  Surgery  of  the  Head  and  Neck.  110  Illustrations. 
2d  Edition.  IS-oo 

MACREADY.  A  Treatise  on  Ruptures.  24  Full-page  Litho- 
graphed Plates  and  Numerous  Wood  Engravings.  Cloth,  J6. 00 

MAYLARD.   Surgery  of  the  Alimentary  Canal.    134  lUus.  $7.50 

MOULLIN.  Text-Book  of  Surgery.  With  Special  Reference  to 
Treatment.  3d  American  Edition.  Revised  and  edited  by  John  B. 
Hamilton,  m.d.,  ll.d.,  Professor  of  the  Principles  of  Surgery  and 
Clinical  Surgery,  Rush  Medical  College,  Chicago.  623  Illustrations, 
over  200  of  which  are  original,  and  many  of  which  are  printed  in 
colors.  Handsome  Cloth,  $6.00;   Leather,  $7.00 

ROBERTS.  Fractures  of  the  Radius.  A  Clinical  and  Patho- 
logical Study.     33  Illustrations.  Ji.oo 

SMITH.  Abdominal  Surgery.  Being  a  Systematic  Description  ol 
all  the  Principal  Operations.    224  Illus.  6th  Ed.    2  Vols.  Clo.,  $10.00 

S'WAIN      Surgical  Emergencies.     Fifth  Edition.         Cloth,  $1.75 

VOSWINKEL.  Surgical  Nursing.  Second  Edition,  Revised  and 
Enlarged,     iii  Illustrations,     ftist  Ready.  $1.00 

WALSHAM.  Manual  of  Practical  Surgery.  6th  Ed.,  Re- 
vised and  Enlarged.     With  410  Engravings.  $3-Oo 

WATSON.  On  Amputations  of  the  Extremities  and  Their 
Complications.     250  Illustrations.  $5-5o 


THROAT   AND    NOSE   (see  also  Ear). 

COHEN.     The  Throat  and  Voice.     Illustrated.  .40 

HALL.      Diseases    of   the    Nose    and    Throat.     Two    Colored 

Plates  and  59  Illustrations.  $2.50 

HOLLOPETER.  Hay  Fever.  Its  Successful  Treatment.  $1.00 
MACKENZIE.     Pharmacopoeia  of  the  London  Hospital   for 

Dis.  of  the  Throat.  5th  Ed.,  Revised  by  Dr.  F.  G.  Harvey.  $1.00 
McBRIDE.    Diseases  of  the  Throat,  Nose,  and  Ear.   A  Clinical 

Manual.    With  colored  Illus.  from  original  drawings.    2d  Ed.       |6.oo 

POTTER.     Speech  and  its  Defects.     Considered  Physiologically, 
Pathologically,  and  Remedially.  |i.oo 


URINE  AND  URINARY  ORGANS. 

ACTON.  The  Functions  and  Disorders  of  the  Reproductive 
Organs  in  Childhood,  Youth,  Adult  Age,  and  Advanced  Life, 
Considered  in  their  Physiological,  Social,  and  Moral  Relations. 
8th  Edition.  $i.75 


MEDICAL  BOOKS.  21 


BEALE.  One  Hundred  Urinary  Deposits.  On  eight  sheets, 
for  the  Hospital,  Laboratory,  or  Surgery.  Paper,  $2.00 

HOLLAND.  The  Urine,  the  Gastric  Contents,  the  Common 
Poisons,  and  the  Milk.  Memoranda,  Chemical  and  Microscopi- 
cal, for  Laboratory  Use.   Illustrated  and  Interleaved.    6th  Ed.    $1.00 

JACOBSON.     Diseases  of  the  Male  Organs  of  Generation.    88 

Illustrations  ^6.00 

KLEEN.     Diabetes  and  Glycosuria.  In  Press. 

MEMMINGER.    Diagnosis  by  the  Urine.    2d  Ed.   24  Illus.   $1.00 

MORRIS.  Renal  Surgery,  with  Special  Reference  to  Stone  in  the 
Kidney  and  Ureter  and  to  the  Surgical  Treatment  of  Calculous 
Anuria.     Illustrated.  $2.00. 

MOULLIN.  Enlargement  of  the  Prostate.  Its  Treatment  and 
Radical  Cure.     2d  Edition.     Illustrated.    Jrist  Ready.  ^i-75 

MOULLIN.  Inflammation  of  the  Bladder  and  Urinary  Fever. 
Octavo.  ?i-5o 

THOMPSON.     Diseases  of  the  Urinary  Organs.    8th  Ed.  $3.00 

TYSON.  Guide  to  Examination  of  the  Urine.  For  the  Use  of 
Physicians  and  Students.  With  Colored  Plate  and  Numerous  Illus- 
trations engraved  on  wood.     9th  Edition,  Revised.  $1-25 

VAN  NUYS.  Chemical  Analysis  of  Healthy  and  Diseased 
Urine,  Qualitative  and  Quantitative.    39  Illustrations.       %\.oo 

VENEREAL  DISEASES. 

COOPER.     Syphilis.     2d    Edition,  Enlarged  and   Illustrated   with 

20  full-page  Plates.  $5-oo 

GOWERS.     Syphilis  and  the  Nervous  System.  i.oo 

VETERINARY. 

ARMATAGE.  The  Veterinarian's  Pocket  Remembrancer. 
Being  Concise  Directions  for  the  Treatment  of  Urgent  or  Rare  Cases, 
etc.     2d  Edition.  Boards,  |i.oo 

BALLOU.  Veterinary  Anatomy  and  Physiology.  29  Graphic 
Illustrations.  .80;  Interleaved,  $1.25 

TUSON.  Veterinary  Pharmacopoeia.  Including  the  Outlines  o< 
Materia  Medica  and  Therapeutics.     5th  Edition.  %^-^h 

WOMEN,  DISEASES  OF. 

BYFORD  (H.  T.).  Manual  of  Gynecology.  Second  Edition, 
Revised  and  Enlarged  by  100  pages.  With  341  Illustrations,  many 
of  which  are  from  original  drawings.  JS-oo 

DUHRSSEN.  A  Manual  of  Gynecological  Practice.  105 
Illustrations.  |r.5o 

FULLERTON.  Surgical  Nursing.  3d  Edition,  Revised  and 
Enlarged.     69  Illustrations.  ^i.oo 

LE^A^ERS.     Diseases  of  "Women.     146  Illus.    5th  Ed.  $2.50 

MONTGOMERY.  Gynecology.  A  Text-Book.  Ab:ut  sec  Illus- 
trations.    Svo.  In  Press. 

WELLS.     Compend  of  Gynecology.     Illustrated.     2d  Edition. 

.80;  Interleaved, Ji. 25 


SUBJECT  CATALOGUE. 


COMPENDS. 


From,  The  Southern  Clinic. 

"  We  know  of  no  series  of  books  issued  by  any  house  that  so  fully 
meets  our  approval  as  these  ?Quiz-Compends?.  They  are  well  ar- 
ranged, full,  and  concise,  and  are  really  the  best  line  of  text-books  that 
could  be  found  for  either  student  or  practitioner." 


BLAKISTON'S  PQUIZ-COMPENDS? 

The  Best  Series  of  Manuals  for  the  Use  of  Students. 
Price  of  each.  Cloth,  .80.  Interleaved,  for  taking  Notes,  $1.25. 

4^  These  Compends  are  based  on  the  most  popular  text-books 
and  the  lectures  of  prominent  professors,  and  are  kept  constantly  re- 
vised, so  that  they  may  thoroughly  represent  the  present  state  of  the 
subjects  upon  which  they  treat. 

4®°"  The  authors  have  had  large  experience  as  Quiz-Masters  and 
attaches  of  colleges,  and  are  well  acquainted  with  the  wants  of  students. 

J$^  They  are  arranged  in  the  most  approved  form,  thorough  and 
concise,  containing  over  6oo  fine  illustrations,  inserted  wherever  they 
could  be  used  to  advantage. 

4^  Can  be  used  by  students  of  any  college. 

4®*  They  contain  information  nowhere  else  collected  in  such  a 
condensed,  practical  shape.     Illustrated  Circular  free. 

No.  I.  POTTER.  HUMAN  ANATOMY.  Sixth  Revised  and 
Enlarged  Edition.  Including  Visceral  Anatomy.  Can  be  used 
with  either  Morris's  or  Gray's  Anatomy.  117  Illustrations  and  16 
Lithographic  Plates  of  Nerves  and  Arteries,  with  Explanatory 
Tables,  etc.  By  Samuel  O.  L.  Potter,  m.d..  Professor  of  the 
Practice  of  Medicine,  Cooper  Medical  College,  San  Francisco  ;  late 
A.  A.  Surgeon,  U.  S.  Army. 

No.  2.  HUGHES.    PRACTICE  OF  MEDICINE.  Part  I.  Sixth 

Edition,  Enlarged  and  Improved.     By  Daniel  E.  Hughes,  m.d., 
Physician-in-Chief,   Philadelphia  Hospital,  late  Demonstrator  ot 
Clinical  Medicine,  Jeflferson  Medical  College,  Phila. 
No.  3.  HUGHES.      PRACTICE    OF    MEDICINE.      Part    II. 
Sixth  Edition,  Revised  and  Improved.     Same  author  as  No.  2. 

No.  4.  BRUBAKER.  PHYSIOLOGY.  Ninth  Edition,  with 
new  Illustrations  and  a  table  of  Physiological  Constants.  Enlarged 
and  Revised.  By  A.  P.  Brubaker,  m.d.,  Professor  of  Physiology 
and  General  Pathology  in  the  Pennsylvania  College  of  Dental 
Surgery ;  Adjunct  Professor  of  Physiology,  Jefferson  Medical 
College,  Philadelphia,  etc. 

No.  5.  LANDIS.  OBSTETRICS.  Sixth  Edition.  By  Henry  G. 
Landis,  m.d.  Revised  and  Edited  by  Wm.  H.  Wells,  m.d.. 
Instructor  of  Obstetrics,  Jefferson  Medical  College,  Philadelphia. 
Enlarged.     47  Illustrations. 

No.  6.  POTTER.  MATERIA  MEDICA,  THERAPEUTICS, 
AND  PRESCRIPTION  WRITING.  Sixth  Revised  Edition 
(U.  S.  P.  1890).  By  Samuel  O.  L.  Potter,  m.d.,  Professor  of 
Practice,  Cooper  Medical  College,  San  Francisco  ;  late  A.  A.  Sur- 
geon, U.  S.  .Ajrmy. 


MEDICAL  BOOKS.  23 


PQUIZ-COMPENDS  ?— Continued. 

No.  7.  WELLS.  GYNECOLOGY.  Second  Edition.  ByWM.  H. 
Wells,  m.d.,  Instructor  of  Obstetrics,  Jefferson  College,  Philadel- 
phia.    140  Illustrations. 

No.  8.  GOULD  AND  PYLE.  DISEASES  OF  THE  EYE 
AND  REFRACTION.  Second  Edition.  Including  Treatment 
and  Surgery,  and  a  Section  on  Local  Therapeutics.  By  George 
M.  Gould,  m.d.,  and  W.  L.  Pyle,  m.d.  With  Formulae,  Glossary  , 
Tables,  and  109  Illustrations,  several  of  which  are  Colored. 

No.  9.  HORWITZ.  SURGERY,  Minor  Surgery,  and  Bandag- 
ing. Fifth  Edition,  Enlarged  and  Improved.  By  Orville 
HoRWiTZ,  B.  S-,  M.D.,  Clinical  Professor  of  Genito-Urinarj'  Surgery 
and  Venereal  Diseases  in  Jefferson  Medical  College  ;  Surgeon  to 
Philadelphia  Hospital,  etc.    With  98  Formulse  and  71  Illustrations. 

No.  10.  LEFFMANN.      MEDICAL    CHEMISTRY.      Fourth 

Edition.     Including  Urinalysis,  Animal  Chemistry,  Chemistry  of 
Milk,  Blood,  Tissues,  the  Secretions,  etc.     By  Henry  Leffmann, 
M.D.,  Professor  of  Chemistry  in  Pennsylvania  College  of  Dental 
'  Surgery  and  in  the  Woman's  Medical  College,  Philadelphia. 

'  No.  II.  STEWART.    PHARMACY.    Fifth  Edition.    Based  upon 

Prof.  Remington's  Text-Book  of  Pharmacy.  By  F.  E,  Stewart, 
M.D.,  PH.G.,  late  Quiz-Master  in  Pharmacy  and  Chemistry,  Phila- 
delphia College  of  Pharmacy ;  Lecturer  at  Jefferson  Medical 
College.     Carefully  revised  in  accordance  with  the  new  U.  S.  P. 

No.  12.  BALLOU.  VETERINARY  ANATOMY  AND  PHY- 
SIOLOGY. Illustrated.  By  Wm.  R.  Ballou,  m.d.,  Professor 
of  Equine  Anatomy  at  New  York  College  of  Veterinary  Surgeons ; 
Physician  to  Bellevue  Dispensary,  etc.     29  graphic  Illustrations. 

No^.  13.  WARREN.  DENTAL  PATHOLOGY  AND  DEN- 
TAL MEDICINE.  Third  Edition,  Illustrated.  Containing 
a  Section  on  Emergencies.  By  Geo,  W.  Warren,  d.d.s.,  Chiet 
ot  Clinical  Staff,  Pennsylvania  College  of  Dental  Surgery. 

No.  14.  HATFIELD.  DISEASES  OF  CHILDREN.  Second 
Edition.  Colored  Plate.  By  Marcus  P.  Hatfield,  Profes- 
sor of  Diseases  of  Children,  Chicago  Medical  College. 

No.  15.  HALL.  GENERAL  PATHOLOGY  AND  MORBID 
ANATOMY,  gi  Illustrations.  By  H.  Newberry  Hall,  ph. o., 
M.D.,  late  Professor  of  Pathology,  Chicago  Post-Graduate  Medi- 
cal School.     Second  Edition. 

No.  i6.  DISEASES  OF  THE  SKIN.  By  Jay  T.  Schamberg, 
M.D.,  Instructor  in  Skin  Diseases,  Philadelphia  Polyclinic.  With 
99  handsome  Illustrations. 

Price,  each,  Cloth,  .80.  Interleaved,  tor  taking  Notes,  $1.25. 

In  preparing,  revising,  and  improving  Blakiston's  ?  Quiz-Com- 
PKNDS  ?  the  particular  wants  of  the  student  have  always  been  kept  in 
mind. 

Careful  attention  has  been  given  to  the  construction  of  each  sentence, 
and  while  the  books  will  be  found  to  contain  an  immense  amount  of 
knowledge  in  small  space,  they  will  likewise  be  found  easy  reading  ; 
there  is  no  stilted  repetition  of  words  ;  the  style  is  clear,  lucid,  and  dis- 
tinct. The  arrangement  of  subjects  is  systematic  and  thorough  ;  there 
Is  a  reason  for  every  word.     They  contain  over  600  illustrations. 


Morris' 
Anatomy 

Second   Edition, 
Revised  and  Enlarged. 


790  Illustrations,  of  which  many 
are  in  Colors. 

Royal  Octavo.     Cloth,  $6.00;  Sheep,  $7.00; 
Half  Russia,  $8.00. 


From  The  Medical  Record,  New  York. 

'•  The  reproach  that  the  English  language  can  boast  of  no 
treatise  on  anatomy  deserving  to  be  ranked  with  the  masterly 
works  of  Heiile,  Luschka,  Hyrtl,  and  others,  is  fast  losing 
its  force.  During  the  past  few  years  several  works  of  great 
merit  have  appeared,  and  among  these  Morris's  "  Anatomy  " 
seems  destined  to  take  first  place  in  disputing  the  palm  in 
anatomical  fields  with  the  German  classics.  The  nomencla- 
ture, arrangement,  and  entire  general  character  resemble 
strongly  those  of  the  above-mentioned  handbooks,  while  in 
the  beauty  and  profuseness  of  its  illustrations  it  surpasses 
them.  .  .  .  The  ever-growing  popularity  of  the  book 
with  teachers  and  students  is  an  index  of  its  value,  and  it 
may  safely  be  recommended  to  all  interested." 


%*  Handsome  Descriptive  Circular,  with 
Sample  Pages  and  Colored  Illustrations, 
will  be  sent  free  upon  application. 


Seventh  Revised  Edition. 


A    UNIQUE     BOOK. 

POTTER'S  MATERIA  MEDICA,  PHARMACY,  AND  THERA- 
PEUTICS. Seventh  Edition,  Enlarged  and  Revised.  A  Hand- 
book, including  the  Physiological  Action  of  Drugs,  Special  Therapeutics 
of  Disease,  Official  and  Practical  Pharmacy,  Prescription  Writing,  etc. 
By  Sam'l  O.  L.  PoTTER,  M.A.,  M.D.,  Professor  of  the  Principles  and 
Practice  of  Medicine  and  Clinical  Medicine,  College  of  Physicians  and 
Surgeons,  San  Francisco,  etc.     Octavo.     929  pages.      Thumb  Index. 

Cloth,  net,  S5.00;   Leather,  net,  S6.00 
This    edition    contains     much    new    material     under    the 
headings  "Albumin,"  "Animal  Extracts,"  "Antitoxins." 

Dr.  Potte-r  has  become  well  known  as  an  able  compiler  by  his  Compends 
of  Anatomy  and  of  Materia  J^Iedica,  both  of  which  have  reached  six  editions. 
In  this  book,  more  elaborate  in  its  design,  he  has  shown  his  literary  abilities  to 
much  better  advantage,  and  all  who  examine  or  use  it  will  agree  that  he  has 
produced  a  work  containing  more  correct  information  in  a  practical,  concise 
form  than  any  other  publication  of  the  kind.  The  plan  of  the  work  is  new, 
and  its  contents  have  been  combined  and  arranged  in  such  a  way  that  it  offers 
a  compact  statement  of  the  subject  in  hand. 

Part  I. — M.\teria  Medica  and  Therapeutics,  the  drugs  being  arranged 
in  alphabetical  order,  with  the  synonym  of  each  first ;  then  the  description  of 
the  plant,  its  preparations,  its  antidotes  and  antagonists,  physiological  action, 
.  and,  lastly,  its  Therapeutics.  This  part  is  preceded  by  a  general  Introduction 
and  a  section  on  the  classification  of  medicines  as  follows  :  Agents  acting  on 
the  Nervous  System,  Organs  of  wSense,  Respiration,  Circulation,  Digestive 
System,  on  Metabolism  (including  Restoratives,  Alteratives,  Astringents, 
Antipyretics,  Antiphlogistics,  and  Antiperiodics,  etc.).  Agents  acting  upon 
Excretion,  the  Generative  System,  the  Cutaneous  Surfaces,  Microbes  and 
Ferments,  and  upon  each  other. 

Part  II. — Pharmacy  and  Prescription  Writing.  Written  for  the  use 
of  physicians  who  put  up  their  own  prescriptions.  It  includes — Weights  and 
Measures,  English  and  the  Metric  Systems.  Specific  Gravity  and  Volume. 
Prescriptions  :  Their  principles  and  combinations  ;  proper  methods  of  writing 
them  ;  abbreviations  used,  etc.  Stock  solutions  and  preparations,  such  as  a 
doctor  should  have  to  compound  his  own  prescriptions.  Incompatibility, 
Pharmaceutical  and  Therapeutical.  Liquid,  Solid,  and  Gaseous  Extempo- 
raneous Prescriptions. 

Part  III. — Special  THERArp:uTics,  an  alphabetical  List  of  Diseases — a 
real  Index  of  Diseases — giving  the  drugs  that  have  been  found  serviceable 
in  each  disease,  and  the  authority  recommending  the  use  of  each ;  a  very  im- 
portant feature,  as  it  gives  an  authoritative  character  that  is  unusual  in  works 
on  Therapeutics,  and  displays  an  immense  amount  of  research.  600  prescrip- 
tions are  given  in  this  part,  many  being  over  the  names  of  eminent  men. 

The  Appendix  contains  lists  of  Latin  words,  phrases,  and  abbreviations, 
with  their  English  equivalents,  used  in  medicine,  Genitive  Case  Endings,  etc. 
36  Formulae  for  Hypodermic  Injections;  a  comparison  of  10  Formulae  of 
Chlorodyne ;  Formulae  of  prominent  patent  medicines ;  Poisons  and  their 
Antidotes  ;  Differential  Diagnosis  ;  Notes  on  Temperature  in  Disease  ;  Clinical 
Examination  of  Urine  ;  Table  of  Specific  Gravities  and  Volumes ;  Table 
showing  the  number  of  drops  in  a  fluidrachm  of  various  liquids  and  the  weight 
of  one  fluidrachm  in  grains,  and  a  table  for  converting  apothecaries'  weights 
and  measures  into  grams. 


Medical  Students'  Manuals* 


VAN    HARLINGEN.      SKIN    DISEASES.     Third    Edition.     The 

Diagnosis  (including  Diflerential  Diagnosis)  and  Treatment  of  Skin  Dis- 
eases. By  Arthur  Van  Harlingen,  late  Lecturer  Jefferson  Medical 
College,  Professor  of  Dermatology,  Philadelphia  Polyclinic,  etc.  Third 
Edition,  Revised  and  Enlarged.     60  Illustrations.  Cloth,  net,  $2.75 

Following  a  short  introduction  devoted  to  symptomatology,  classification,  etc.,  each 
disease  is  taken  up  in  alphabetical  order;  special  attention  is  given  to  treatment,  and 
there  are  a  number  of  tables  of  differential  diagnosis  that  will  prove  particularly 
useful. 

A  great  deal  of  new  material  has  been  added  to  this  edition  ;  some  of  the  old  sections 
have  been  entirely  rewritten,  and  many  new  methods  of  treatment  with  accompany- 
ing formulae  have  been  incorporated. 

WALSH  AM.  SURGERY.  Sixth  Edition.  Surgery:  Its  Theory 
and  Pidctice.  By  Wm.  J.  Walsham,  m  d.,  Assistant  Surgeon  to,  and 
Lecturer  on  Anatomy  at,  St.  Bartholomew's  Hospital,  London,  etc.  410 
Illustrations.     846  pages.  Cloth,  net,  %'^.oo 

"Walsham,  besides  being  an  excellent  surgeon,  is  a  teacher  in  its  best  sense,  and 
having  had  very  great  experience  in  the  preparation  of  candidates  for  examination, 
and  their  subsequent  professional  career,  may  be  relied  upon  to  have  carried  out  his 
work  successfully.  Without  following  out  in  detail  his  arrangement,  which  is  excel- 
lent, we  can  at  once  say  that  his  book  is  an  embodiment  of  modern  ideas  neatly  strung 
together,  with  an  amount  of  careful  organization  well  suited  to  the  candidate,  and, 
indeed,  to  the  practitioner'." — British  Medical  Journal. 

HOLDEN'S  MANUAL  OF  DISSECTIONS.  Seventh  Edition. 
311  Illustrations.  By  John  Langton,  f.r.c.s..  Lecturer  on  Anatomy, 
St.  Bartholomew's  Hospital.  Revised  by  A.  Hewson,  m.d..  Demon- 
strator of  Anatomy,  Jeff^erson  Medical  College ;  Chief  of  Surgical  Clinic, 
Jefferson  Hospital;  Mem.  Assoc. Amer.  Anatomists,  etc.  In  Press. 

"  The  work  before  us  is  a  brilliant  example  of  the  new  order  of  text-books.  ... 
We  would  call  special  attention  to  the  character  of  the  illustrations  with  which  the 
volume  is  bountifully  furnished." — American  Journal  of  Medical  Sciences. 

WHITE  AND  WILCOX.  MATERIA  MEDICA,  PHARMACY, 
PHARMACOLOGY,  AND  THERAPEUTICS.  Fourth  Edition. 
By  William  Hale  White,  m.d.,  f.r.c. p.,  etc..  Physician  to,  and 
Lecturer  on  Materia  Medica,  Guy's  Hospital  ;  Examiner  in  Materia 
Medica,  Royal  College  of  Physicians,  London,  etc.  Fourth  American 
Edition.  Revised  in  accordance  with  the  U.  S.  P.  by  Reynold  W. 
Wilcox,  m.a. ,  m.d. ,  Professor  of  Clinical  Medicine  at  the  New  York 
Post-Graduate  Medical  School  and  Hospital  ;  Assistant  Visiting  Physician, 
Bellevue  Hospital.  Cloth,  ne't,  $3.00 

"  Practical  experience  with  Dr.  White's  book  on  general  therapeutics,  both  as  to  its 
usefulness  to  the  student  and  as  to  the  soundness  of  the  advice  which  he  gives,  has 
proved  that  he  is  an  author  upon  whom  much  dependence  may  be  placed,  and  a  care- 
ful examination  of  the  American  version  of  his  second  work,  which  has  been  published 
under  Dr.  Wilcox's  eye,  shows  that  it  is  also  worthy  of  both  its  author  and  editor."— 
Therapeutic  Gazette. 

4®="  See  Next  Page. 


P.  BLAKISTON'S  SON   &  CO.,  Publishers  and   Booksellers, 

1012  Walnut  Street,  Philadelphia. 


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BARTLEY.  MEDICAL  CHEMISTRY.  Fifth  Edition.  A  Text- 
Book  for  Medical,  Dental,  and  Pharmaceutical  Students.  By  E.  H. 
Bartley,  M.D.,  Professor  of  Chemistry  and  Toxicology  at  the  Long 
Island  College  Hospital ;  late  Chief  Chemist,  Board  of  Health  of 
Brooklyn,  N.  V.,  etc.  Revised  and  Enlarged.  With  92  Illustrations, 
Glossary,  and  Complete  Index.     i2mo.  Cloth,  mt,  S3. 00 


P.   BLAKISTON'S  SON   &  CO.,  Publishers  and   Booksellers, 

1012   WALNUT    STREET,    PHILADELPHIA. 


